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  1. TNCR
  2. General Discussion
  3. Medicare to Require Prior Authorization Using AI

Medicare to Require Prior Authorization Using AI

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  • AxtremusA Offline
    AxtremusA Offline
    Axtremus
    wrote last edited by
    #1

    So, Medicare recipients, tell me how much you love this.

    https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.j08.OBSD.3D8TzvEfhIru

    Medicare Will Require Prior Approval for Certain Procedures

    The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections.

    1 Reply Last reply
    • MikM Away
      MikM Away
      Mik
      wrote last edited by Mik
      #2

      I've been working on a project like this for a couple years now involving a private insurer. It's an excellent
      application of AI as long as there is a human-centric appeals process. It will make routine approvals instantaneous. My concern would be for the not-so-routine cases which are certain to occur, and I'm not crazy about hiring private companies to do it. The latter concern is due to one tech company I've been working with who has not met my expectations.

      "The intelligent man who is proud of his intelligence is like the condemned man who is proud of his large cell." Simone Weil

      1 Reply Last reply
      • MikM Away
        MikM Away
        Mik
        wrote last edited by
        #3

        This is my Congressman, Greg Landsman. Ohio is one of the states piloting this. While I do not fully trust him yet I have seen a lot of good signs. If what he says is true about the incentives for the tech company, it's a bad thing.

        Link to video

        "The intelligent man who is proud of his intelligence is like the condemned man who is proud of his large cell." Simone Weil

        1 Reply Last reply
        • taiwan_girlT Online
          taiwan_girlT Online
          taiwan_girl
          wrote last edited by
          #4

          (Different topic, but why do (almost) only politicians wear little message buttons/medals/pins/flags on their suits and dresses?

          Actually, I think I know the answer. They are trying to show that they are more (patriotic, moral, good for a cause, etc) than the average person. Seems so fakish to me.)

          1 Reply Last reply
          • MikM Away
            MikM Away
            Mik
            wrote last edited by
            #5

            They want to look like the Soviet Politburo.

            "The intelligent man who is proud of his intelligence is like the condemned man who is proud of his large cell." Simone Weil

            taiwan_girlT 1 Reply Last reply
            • MikM Mik

              They want to look like the Soviet Politburo.

              taiwan_girlT Online
              taiwan_girlT Online
              taiwan_girl
              wrote last edited by
              #6

              @Mik 555

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