The Healthcare Black Box: Prior Authorization, AI Denials, and Fiduciary Duty (Ep. 54)
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In this episode of The Benefit Whisperer, Ralph Weber is joined by Dr. Don Berwick, former head of CMS; Dr. Kevin Schulman of Stanford; and David Scheinker, PhD, for a timely conversation about prior authorization, AI, healthcare contracts, and the hidden complexity employers are expected to accept.
The discussion begins with a critical question: if a prior authorization denial moves faster because of AI, but the underlying rule is still hidden, has the system actually improved?
Ralph and his guests examine how prior authorization evolved, how financial incentives can distort clinical review, and why employer health plans remain difficult to understand, compare, audit, or defend. They also discuss the variation in prior authorization rules across insurers, the administrative burden placed on providers, and the fiduciary responsibility employers carry when purchasing healthcare for their employees.
This conversation challenges employers to ask better questions before signing another healthcare contract.
Because faster opacity is still opacity.
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