Health Insurance

How benefits leaders can evaluate whether AI-powered health plans improve employee access to care

Read Time

5 Minutes

Written by

Team Curative

Featured Insights by

Isaac Turner, CTO, Co-Founder

Published

Jan 7, 2026

What to look for when AI meets health care — and how it can transform your employees' experience

AI can be a serious game-changer in health care.

And it’s starting to play a serious role in the industry: 22% of health care organizations are using domain-specific AI tools this year. That’s a 7x increase from 2024 and 10x from 2023.

Our co-founder and CTO Isaac Turner is leading the charge in AI integration at Curative. He knows that when it comes to health plans, AI can foster better employee health care experiences, faster approvals, and less administrative friction.

He’ll share how you can identify what health plans use AI effectively, improving member experience and boosting your bottom line.

How to evaluate AI-enabled member experiences

Key Takeaways:

AI should work within existing health care workflows, not force providers to adopt new systems.
AI-powered health plans can dramatically reduce administrative burden.
Speed metrics reveal AI effectiveness.

AI works when it’s within health care systems, not working against them

There are numerous delays that affect people’s medical care, and these delays often have more to do with administrative burdens vs. medical necessity.

Providers submit 100-page faxes because they are unsure of what insurance companies require for prior authorization. Members get stuck in a phone loop of companies and providers that keep saying, “Call the other one.”

People end up in medical limbo for days because no one’s on the same page.

"The member has to wait,” Turner said. “The patient is waiting for us and the provider to get on the same page about whether this is covered."

And this doesn’t just happen because someone has a complicated medical situation. It also happens for plenty of routine procedure approvals.

Workers get more frustrated, especially when provider offices blame "insurance delays" while the real issue is a paperwork overload.

As he worked to implement AI, Turner and his team realized that forcing providers to adopt new systems would only create more friction for employees.

Instead, they considered how AI could complement the analog nature of health care while still providing people with digital speed and faster results.

Effective AI meets providers where they are to help employees get access to care faster. In a few steps, benefits leaders can identify plans that reduce friction with AI, rather than creating digital barriers.

How to evaluate AI-enabled member experiences

While AI is being adopted across the board in health care settings, not all AI is created equal.

Here’s how you can ensure it's useful for you and your employees.

Step 1: Assess the speed of their prior authorizations

The very first thing you want to do is ask your potential health insurance partners what their average prior authorization turnaround time is, and what percentage of cases are handled the same day. Even better is if they can process routine authorizations in just hours.

With effective AI integrations, Turner said, "Time to answer the phone will always be two rings. Time to turn around a prior authorization request will be same-day."

Step 2: Evaluate the responsiveness of member and provider support

Find out the average hold times for both members and providers, and whether AI handles routine inquiries 24/7. You want to make sure that complex cases can still reach knowledgeable humans quickly, so there’s no friction — and that AI recognizes those situations.

Ask them for specific metrics on how their AI reduces employee waiting periods, too. Of course, fast approvals mean nothing if employees can't reach someone when they need help.

Step 3: Examine their proactive care navigation capabilities

Does this insurance plan offer support? When your employee needs a dermatologist, can its AI find a nearby doctor and book the appointment? When a system has proactive outreach for preventive care, employees stay healthier and catch conditions sooner.

Look for AI-powered appointment scheduling assistance, and ask yourself whether the partner’s system can handle complex navigation tasks.

Step 4: Verify gradual, trust-building implementation

You don’t just want a system that looks good. It needs to actually be and stay effective for your employees.

Ask about their AI implementation timeline and testing approach. The response will tell you if they're rushing deployment or building gradually (slow and steady wins the race!).

Making a better employee health care experience

When your insurance company uses AI effectively, you’ll see lower waiting times — immediate answers, not 20-minute holds — and same-day prior authorizations for routine procedures. Faxed medical records can be read and approved at lightning speed. Of course, medical experts will still be required to assess complex needs and make medical determinations, especially where a procedure may be deemed not medically necessary.

Plus, a well-trained AI system that’s built with the proper health care context will continue to learn and support human intervention on complex cases.

For example, Turner said, Curative’s AI voice agents handle provider calls: “Everyone waits for two rings, and then they have an agent on the end who can help them very quickly." In two weeks, they processed 600 hours of calls (equivalent to the volume of 15 full-time employees). The system can scale infinitely. Plus, during peak times, there’s no limitation to staffing.

When employees get agentic assistance, it speeds up their care: there’s less administrative burden and providers get instant confirmations, which accelerates scheduling.

FAQs

How can I tell if a health plan's AI is actually effective?

Ask potential partners about their average prior authorization turnaround time, what percentage of cases are handled same-day, and their average hold times for members and providers. Effective AI should deliver measurable improvements, not just promises of "innovation."

If we utilize AI, will it be more challenging for employees to contact a live person when they have complex issues?

Not if it’s implemented correctly. The best AI-powered health plans use technology to handle routine inquiries and administrative tasks 24/7, which frees up human staff to focus on complex cases.

How quickly will I see results from an AI-powered health insurance partner?

You should see immediate improvements in basic metrics like hold times and routine authorization speeds. However, AI that works well is implemented gradually, and frequently tested. Ask potential partners about their implementation timeline and testing approach.