AI-Driven Medicare Prior Authorization Delays and Denials Harm Patients
A federal AI prior authorization system called WISeR launched by the Centers for Medicare & Medicaid Services is reportedly delaying approval of medical procedures for seniors in six states by two to four times longer than before, with some patients waiting weeks only to receive unexplained denials. Senator Maria Cantwell released a report citing data from Washington hospitals showing authorization times have increased from around two weeks to four to eight weeks, and questioned HHS Secretary RFK Jr. about the system in a Senate Finance Committee hearing.
What happened
The Wasteful and Inappropriate Services Reduction (WISeR) model, an AI-driven prior authorization system launched by the Centers for Medicare & Medicaid Services on January 1, 2026, requires Medicare patients in six states—Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington—to obtain pre-approval for 13 types of procedures or treatments.
According to a report compiled by Senator Maria Cantwell using survey data from the Washington State Hospital Association, patients waiting for authorization now require four to eight weeks compared to a previous average of around two weeks. In some cases, patients wait weeks only to receive denial without explanation, requiring them to restart the process.
Reported impact
The delays are worsening health outcomes for seniors in Washington whose care is postponed. Wait times for approval frequently exceeded the CMS' standards for the model, which aimed to provide responses within three days for routine care and one day for urgent care.
Providers report increased administrative burden. Hospitals, doctors, and patients have contacted Senator Cantwell about the delays and denials.
Index analysis
The AI system is functioning as a denial device by flagging procedures for manual review that were previously approved automatically under traditional Medicare, creating bottlenecks where decisions that should take days instead take weeks.
Governance controls
Under RFK Jr.'s leadership at HHS, the WISeR model was authorized as a pilot program intended to reduce healthcare spending by cutting down on services deemed wasteful or inappropriate.
Classification
Sources and evidence
This record was researched and written by the Index, based on the following original reporting.