The fax machine in a Florida rheumatologist's office, the least futuristic object in any American clinic, still receives a steady stream of prior authorisation decisions from health insurers. In early April 2026, one of those faxes, addressed to a patient the Palm Beach Post would eventually call only by her first name, Iris, came back in under the time it takes to pour a cup of coffee. The request had been submitted a few minutes earlier. The reply, denying coverage for an injection she had been receiving for years, was generated, signed, and transmitted without any documented human pause in the middle. Iris is 80. Her hands, on the worst mornings, do not open. Her doctor, looking at the timestamp, understood instantly what had happened. The claim had not been reviewed. It had been processed.
The word processed has started to carry a weight it was never designed to hold. In the American health insurance system in 2026, it is the polite term for an event that, in almost any other domain of life, we would call a decision: a binding determination about whether a human being will have access to the medical care their doctor has recommended. Except the entity making the decision is not a person. It is a model. And the model, as anyone who has tried to ask one why it did what it did already knows, does not owe anyone an explanation.
