Bill Curry, a 65-year-old cattle farmer from rural Oklahoma, has been traveling to Oklahoma City for epidural injections to treat his back pain. However, due to Medicare’s new AI-powered prior authorization program, Curry has experienced unexpected delays and extra trips.
Medicare’s Prior Authorization Program
In January, Oklahoma became one of six states to begin a pilot program testing the use of preapprovals in traditional Medicare. The program, called the Wasteful and Inappropriate Service Reduction Model (WISeR), is powered by artificial intelligence and aims to reduce waste, fraud, and abuse in the Medicare system.
However, early reviews from Oklahoma and other pilot states suggest that WISeR’s rollout has not been smooth. Patients, doctors, and healthcare professionals have reported confusion, errors, long wait times, and stress due to the program. Some have described the rollout as ‘horrendous’ and say that Medicare patients are now getting ensnared in the same red tape as those with private insurance.
One key concern is that the program was implemented too hastily. WISeR was announced in June 2025 and launched in mid-January, which was ‘quicker than normal’ for the federal government, according to Todd Baker, former CEO of the Ohio State Medical Association.
Government contractors have also acknowledged the rapid pace of the rollout. Jeremy Friese, CEO of Humata Health, the vendor for Oklahoma, said that ‘we’ve had an aggressive rollout from the time of being notified to going live.’ Tech executives servicing other states have said that they were still adding features to their products in the spring.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, said that the goal of the program is to ensure that prior authorization is efficient, fast, and streamlined. ‘The model aims to reduce inappropriate care without delaying appropriate care,’ he said.
Impact on Patients and Doctors
Patients and doctors have reported significant delays and errors due to the program. Curry, the Oklahoma cattle farmer, said that he might go to Kansas for future treatments to avoid the approval process. Dorota Gribbin, a New Jersey-based physical medicine and rehabilitation physician, said that one of her patients had to go to the hospital for more expensive care because the authorization came too late.
Doctors have also reported frustration with the prior approval and reimbursement process. Jerry Sobel, a Phoenix-area pain management doctor, said that the rollout has been ‘horrendous’ and that he hasn’t gotten paid by Medicare for nine epidurals as of May.
The University of Washington’s medical system alone had nearly 100 patients waiting for epidural injections due to WISeR-related delays, according to a report from the office of U.S. Sen. Maria Cantwell (D-Wash.).
Original reporting: Texarkana Gazette — read the source article.
