Article Image

This Doctor Is Using a Chatbot For Prior Authorizations

Op-Med is a collection of original articles contributed by Doximity members.

ChatGPT, an artificial intelligence program that can be used to debug code, do math problems, and write everything from poetry to college essays, was all the buzz on every social platform last year. One unusual use that went viral, however, was a practical application for the medical community: generating prior authorization letters.

“It's just a fun way to go about writing a letter,” said Dr. Cliff Stermer, a rheumatologist who demonstrated on TikTok how simple it was to write an insurance appeal using ChatGPT, and subsequently garnered more than 143,000 views at the time of this article.

“This program is the first time where artificial intelligence is more accessible to the general public. Especially [for] us doctors — insurance companies and other larger companies have already been using artificial intelligence to draft articles or to decide what imaging is approved or denied based on certain algorithms,” Dr. Stermer said. 

In his TikTok, Dr. Stermer demonstrates how accessible it is. He prompts the chatbot: “Write a letter to United Healthcare asking them to approve an echocardiogram on a patient with systemic sclerosis. Make reference to supporting scientific literature and list the appropriate articles.” Within a minute, the program spits out a three-paragraph letter. 

But Dr. Stermer notes a caveat: Though it can write a great template, it is not yet advanced enough to produce a ready-to-print letter, and the requester will need to make “significant” revisions to the result.

“[For] a lot of doctors, it would take a long time to sit down and write a letter. So [ChatGPT] does a great job of getting a good template out there,” Dr. Stermer said. “[However], it will happily make up facts and references that are not correct or not accurate. It will sound accurate because it will get the proper name, let's say, of the author, but it won't put the proper article. It won't reference the proper journal. So you have to be very careful.” For example, in his TikTok, the letter references a study from 2000 that does not appear to exist.

One reason for these mistakes is that ChatGPT is not connected to the internet, though it does have access to information prior to 2021. This is a downside to using ChatGPT for prior authorizations, Dr. Stermer noted, as requests are often made for new treatments.

“Many times when we're trying to get something approved, it's because it's a newer agent, or there's new data that the insurance companies don't know about. And we want to say ‘Oh, this medicine. It was just FDA-approved last month for this and this condition,’” Dr. Stermer said. 

A way around these mistakes is to provide the specific articles you want the bot to reference, though Dr. Stermer emphasizes that you double-check the resulting letter, regardless. Another tip of Dr. Stermer’s is to specify tone, like “friendly,” “formal,” or “stern.”

Dr. Stermer has also experimented to see how accurate it would be in diagnosing and treating a patient. Because you can ask the program to build on its previous response, Dr. Stermer could go back and forth with the chatbot. 

“I asked, ‘How would you treat a patient with polymyalgia rheumatica?’ And it outlined a pretty good outline of how to treat it. And then I said, ‘What if a patient can’t tolerate this first medication?’ And it kind of gave a good second answer also. And then the third answer was totally wrong. It's not quite there where it's replacing doctors, but I think it's only a matter of time before artificial intelligence is used as a tool to help us guide our treatment options and help our patients,” he said.

Though Dr. Stermer hasn’t had an opportunity to use one of his new templates yet in a real claim and therefore can’t say if he’s having a higher success rate with letters written by an application, he looks forward to making AI like ChatGPT part of his regular practice.

“It's interesting new technology. It's going to change the way a lot of people operate. You know, whether that's writers or lawyers or doctors,” said Dr. Stermer. “It’s going to change the way we lead our daily lives.”

Image: vladwel / Shutterstock

All opinions published on Op-Med are the author’s and do not reflect the official position of Doximity or its editors. Op-Med is a safe space for free expression and diverse perspectives. For more information, or to submit your own opinion, please see our submission guidelines or email

More from Op-Med