DEPLOYMENT · US
Health insurers deploy AI upstream into pre-authorization and care-pathway decisions
Sun Life and peers are shifting AI from claims processing (post-care) to pre-authorization gates and treatment recommendations (pre-care). Automates which patients get flagged and which pathways are pre-approved.
WHY IT MATTERS
AI moves from retrospective audit to prospective gatekeeping. Increases algorithmic liability and discrimination risk; CROs must stress-test fairness, bias, and appeal mechanisms before deployment.
Source: PYMNTS · 2026-08-10