The American Medical Association (AMA) House of Delegates (HOD) adopted a new policy this week directing the AMA to “advocate for greater regulatory oversight of the use of augmented intelligence for review of patient claims and prior authorization requests.”

The new policy is the result of a resolution offered by the ASGE for consideration during the AMA’s June meeting. ASGE submitted the resolution after UnitedHealthcare (UHC) announced plans to implement a prior authorization program for endoscopy services.

Speaking in support of the resolution, ASGE AMA Delegate Walter Park, MD, noted the potential value of artificial, or augmented, intelligence (AI) in the health care system, but added ASGE’s recent experience with UHC is cause for concern that AI is not being used by payers in the best interest of patients.

In his remarks to his fellow delegates, Dr. Park noted a recently published ProPublica story that alleges Cigna used a computer algorithm to review requests for authorization and then had physicians sign off on batches of denied claims without proper review. “Our resolves ask our AMA to advocate for greater regulatory oversight of the use of AI by payers in prior authorization practices, specifically requesting that their processes be reviewed by doctors and other health care professionals with relevant expertise prior to denial,” said Dr. Park.  

ASGE is grateful for the support of the resolution by the HOD and looks forward to continuing to work within the House of Medicine to the advance meaningful prior authorization reform.