The growing complexity of insurance claims and prior authorization processes in oncology is creating significant administrative burdens and delaying timely access to care. Experts from Tennessee Oncology and Vanderbilt University Medical Center highlight how manual, error-prone workflows contribute to treatment delays — sometimes with serious consequences — and place substantial strain on clinicians and patients. While AI tools could streamline repetitive tasks, automate documentation extraction, and speed up appeals, the article emphasizes that technology alone cannot solve deeper systemic issues. The experts call for a broader reassessment of the role of prior authorization in cancer care, urging insurers, legislators, and clinicians to collaborate on balancing resource stewardship with patient outcomes, especially in a field where timely treatment is critical.
The process of submitting insurance claims and appealing coverage denials related to oncology treatments has been growing increasingly complex as treatment paradigms expand. Incorporating AI tools into daily workflows may allow oncology professionals to save time contending with insurance denials and re-allocate attentions back toward face-to-face patient care. However, larger issues are also at play that indicate the need for insurance companies, legislators, and oncologists to collaboratively determine a balance optimal resource utilization and prioritizing patient outcomes.
OncLive gathered insights from the following experts about the challenges of prior authorization, the potential use of AI tools for claims management, and the need for structural re-evaluation of the insurance claims process within oncology: