Most of the AA Insider fares that are pay with points are booked as F80O fares which are no change fee and fully refundable (to travel voucher) fares. They just incur a $39 fee from Amex if you do make a change.

You can book the F80O fares over the phone for cash pricing (plus the $39 ticketing fee) but if you’re paying with points you can do it on the Amex Travel site.

I often book these fares if my travel plans are uncertain.