The system did not break. It is working exactly as designed. Four of them. The second one should not be legal. SEND this to whoever fights this queue with you. Denial letter: "This request was reviewed by our clinical decision system." Me: "I would like to appeal to a human." Rep: "Your appeal will be reviewed." Me: "By a human?" Rep: "By the system." Admin: "The inbox drafts your replies with AI now." Me: "Does it send them?" Admin: "No, you review and approve." Me: "So the work is reading." Admin: "Yes." Me: "The work was always reading." EMR: "Select laterality." Me: "It's the brainstem." EMR: "Select laterality." Me: "It is in the middle." EMR: "Right." Me: "No — the MIDDLE." EMR: "Right." Midline structures. The software has two options and the anatomy has three, and only one of us is going to bend. Pharmacy benefit: "Denied. Patient must fail a preferred alternative first." Me: "This is the first drug ever approved for this disease." Benefit: "Then the preferred alternative is nothing." Me: "They already failed nothing. For thirty years."

EXPLAINED (ACCURACY-CHECKED)

(1) In a 2025 AMA physician survey, 61% of physicians reported concern that payer use of AI would increase denials of medically necessary care; several US states passed 2025 laws barring AI from being the sole basis for a medical-necessity denial without human review. (2) AI-drafted patient-message replies shift clinician effort from composition to review and approval; studies of draft-reply tools have shown reductions in subjective burden with modest or absent reductions in actual handling time. (3) Midline structures such as the brainstem, corpus callosum and vermis are not lateralized to a left or right side. A required left/right laterality field cannot correctly describe a midline lesion. (4) Several 2026 neurology approvals are first-ever therapies for their indication — the FDA decisions tracked for September 2026 include agents for ataxia-telangiectasia and Alexander disease, conditions with no previously approved treatment. Step-therapy policies require documented failure of a preferred agent before a requested drug is covered.