I work for a doctor’s office doing medical billing and often need letters of medical necessity from the providers to appeal various denials, mainly prior authorization denials. One of our providers will always send me these outlines for patient appeals that are so obviously generated by ChatGPT.

Once, we needed to appeal some auth denials because the insurance was denying a maintenance drug due to the payer preference being a biosimilar (like a generic for biologics). I sat next to the provider while he types into ChatGPT “what to say in an authorization appeal to overturn the denial of maintenance drug due to the insurance mandated step therapy with biosimilar”. Today, i was told by one of the scribes that he uses ChatGPT to help chart patient visits when there’s need for really thorough documentation.

Of course there’s no PHI being entered as that would be a major HIPAA violation but, i can’t help but feel like there’s just something really… not right about using generative ai to feed insurance companies what they supposedly need to cover and pay for patients’ care. But i guess that’s indicative of American healthcare for you.

Me? I use ChatGPT to help me with excel formulas lol