The Healthcare Black Box: Prior Authorization, AI Denials, and Fiduciary Duty (Ep. 54)

Prior authorization was supposed to help ensure patients receive appropriate care. But what happens when it becomes a tool for delay, denial, and financial friction? 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 direct conversation about prior authorization, AI, opaque healthcare contracts, and the hidden administrative costs employers can no longer afford to ignore. The group explores why adding AI to a broken, opaque system may not solve the problem. It may simply make the wrong incentives move faster. If a denial moves from a fax machine to an API, but the underlying rule is still hidden, have we improved healthcare? Or have we just digitized the black box? This episode covers: -Prior authorization denials and delays -Why AI could accelerate healthcare’s worst incentives -The lack of standardization across insurer rules -Hidden contract complexity in employer health plans -Administrative waste and transaction costs -ERISA fiduciary responsibility -Why employers should demand more transparency before signing healthcare contracts -How digital contracts and standardization could reduce chaos For employers, benefit leaders, advisors, and anyone responsible for healthcare purchasing, this conversation is a must-listen. Healthcare does not need a faster black box. It needs accountability. Subscribe to The Benefit Whisperer for direct conversations about healthcare waste, fiduciary responsibility, employer-sponsored benefits, and the systems driving up healthcare costs.