Medicare's AI Preapproval Pilot Delays Care in 6 States as 88% of Supported Cases Get Instant Yes
Updated
Updated · CBS New York · Jun 23
Medicare's AI Preapproval Pilot Delays Care in 6 States as 88% of Supported Cases Get Instant Yes
3 articles · Updated · CBS New York · Jun 23
Summary
Six pilot states that began using Medicare's WISeR preapproval system in January are reporting delayed procedures, payment backlogs and apparent review errors for services including epidurals and kyphoplasty.
13 services were put under prior authorization to curb fraud and unnecessary care, and CMS says the AI-assisted process should return decisions within 72 hours with an immediate approval in 88% of clinically supported cases.
Nearly 100 University of Washington patients were waiting for epidural injections earlier this year, while Oklahoma providers reported six- to eight-week payment delays and one Arizona doctor said denials cited the wrong body region.
CMS and vendors say humans make final decisions and backlogs are being resolved, but doctors say the rushed rollout has imported private-insurance-style red tape into traditional Medicare and may increase appeals costs.
69% of insured adults call prior authorization a care burden, and some clinicians fear WISeR could expand beyond the current six states if Medicare shows it saves money.
As Medicare's new AI denies care, are doctors losing the final say on patient treatments?
With Medicare's AI now facing lawsuits, what secrets are hidden inside its decision-making algorithms?
2026 WISeR Model Rollout: AI-Driven Medicare Denials, Stakeholder Pushback, and Oversight Challenges
Overview
Launched in January 2026, the CMS Wasteful and Inappropriate Service Reduction (WISeR) pilot program quickly faced major challenges and criticism. The program lets private companies use artificial intelligence to review medical care requests from older Americans, with a controversial incentive that rewards these companies for denying requests. This incentive structure became a central point of concern, especially for its impact on Medicare prior authorizations. As the program rolled out, it led to immediate real-world effects, including formal complaints and corrective findings, with state hospital associations and congressional oversight bodies documenting significant issues.