Bill Curry, 65, raises cattle on the same property in rural Oklahoma that was once owned by his father and previous generations. Every quarter for several years, he has made the two-and-a-half hour drive to Oklahoma City to receive a spinal epidural to treat back pain.
But this year, due to new things, medicare On the show, Curry started traveling a little more frequently.
During one trip in February, he was unexpectedly told that he needed pre-approval for the surgery. Then, about a month later, he went back for the injection, traveling a total of 10 hours. His clinic wanted him to come in for a third time, something they had never asked him to do before. Curry said she didn’t go because the appointment was “just filling out a piece of paper to express my feelings again.”
In January, Oklahoma became one of six states to launch a pilot program to test the use of prior authorization in traditional Medicare, the federal health insurance program for people 65 and older or with disabilities. Medicare previously avoided this practice. prior permission – The patient or someone on their health care team must seek insurance approval before proceeding with certain procedures, tests, or prescriptions.
Epidurals like Curry’s are one of 13 medical services eligible for the new program, as the Trump administration says they tend to: scam or misuse. The artificial intelligence-powered program, called the Wasted and Inappropriate Services Reduction Model (WISeR), is intended to save the federal government money and protect patients from potentially unsafe or unnecessary care.
However, early reviews from Oklahoma and other testing states (Arizona, New Jersey, Ohio, Texas, and Washington) suggest that the rollout of WISeR has not been smooth. Patients, doctors and other medical professionals who spoke to KFF Health News said the effort is creating confusion, mistakes, long wait times and stress. Some described the development as “scary” and said people enrolled in Medicare in pilot states are being thrown into the same red tape as those with private insurance.
One of the key concerns is that everything was done too hastily. WISeR was announced in June 2025 and launched in mid-January.
Todd Baker, who recently resigned as CEO of the Ohio Medical Association, said this was “earlier than normal” for the federal government. Jeb Shepherd, director of policy for the Washington State Medical Association, added that doctors “needed to figure it out somehow.”
Government contractors also acknowledge the fast pace. “We’re very excited to be able to deliver this product,” said Jeremy Friese, CEO of Humata Health, an Oklahoma vendor. Technology company executives serving other states said they were still adding features to their products in the spring.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, which is managing the program, would not comment on the rollout schedule. But he said in a statement that the purpose of these reforms is to ensure that prior authorization is efficient, fast and streamlined.
“This model aims to reduce inappropriate care without delaying appropriate care,” he said.
Mehmet OzLeaders at the Centers for Medicare and Medicaid Services told NewsNation in December that they are “rolling out preauthorization for abusive practices.”
“The purpose of these is not to deny care,” Oz continued. “It’s about making sure you get the treatment you need and deserve, not the treatment some unscrupulous doctor is trying to give you.”
Medicare has struggled in recent years with allegations of fraud related to certain services. The Department of Health and Human Services’ inspector general warned in September that the program’s spending on skin substitutes, for example, had surged nearly 700% in two years, raising “significant concerns about fraud, waste and abuse.” Skin substitutes are one of 13 treatments currently under review under WISeR.
The program also imposes prior authorization requirements for kyphoplasty, a procedure for spinal fractures that a Medicare Payment Advisory Commission report found is overused.
However, Mr Sutton acknowledged that “the proportion of providers who are wasteful, fraudulent and abusive is small”.
Many consumers and clinicians dislike prior authorization. Even as federal health officials test Medicare’s procedures, the Trump administration is trying to roll them back for people with private insurance. According to a KFF poll conducted in January, 69% of insured people believe that prior authorization would make their care a burden.
Physicians and their staff log into an online portal through WISeR and submit medical records justifying the procedure. Humata CEO Friese told KFF Health News that the system uses artificial intelligence to quickly approve applications that meet the program’s criteria. He said the answer was an “immediate yes” in 88% of cases where clinical data supported approval.
CMS touts this process as one that returns a decision within 72 hours. Clinicians will then receive a “universal tracking number” that they can use to schedule procedures and receive payment. But in reality, participants say the process is far from easy.
At the University of Washington Health System alone, nearly 100 patients were waiting for epidural injections earlier this year due to WISeR-related delays, according to an April report from the office of Sen. Maria Cantwell (D-Wash.) based on hospital association data. “Patients are now exposed to delays and denials that did not exist before the WISeR model,” the report states.
Curry, an Oklahoma cattle farmer, said he may go to Kansas for future treatment to avoid the approval process. Dorota Gribbin, a New Jersey-based physical medicine and rehabilitation physician, said that by the time one of her patients needed treatment for back pain was cleared, the patient had gone to the hospital for more expensive treatment.
Jennifer Valle, precertification and insurance supervisor for Oklahoma Clinical Radiology, said there were many “pointers” from examiners regarding kyphoplasty. She said sometimes information that practices provide to CMS is overlooked and reviewers request images that are already on file.
James Webb, a musculoskeletal radiologist in Tulsa, Okla., said he, too, is frustrated with the pre-approval and reimbursement process for kyphoplasty surgery, where successful claims are supposed to be paid within 15 days. “We’re seeing a delay of six to eight weeks,” he said.
“It was terrible,” said Jerry Sobel, a pain management doctor in the Phoenix area. “It looked like there was no tissue from the beginning,” said Sobel, who had not received payment from Medicare for nine epidurals as of May.
“We are continually monitoring our operations and working closely with our stakeholders to address questions and improve the provider experience,” said Sundar Subramanian, CEO of Zyter, which has the Arizona contract.
In an April webinar, another Zeiter executive acknowledged that the company is still owed a large amount of money until January. Medicare’s Sutton said those backlogs are “currently being resolved” but provided no further details.
Asked about other issues, such as doctors suspecting mistakes made by AI, Medicare’s Sutton said the agency appreciates “feedback about the provider experience.” He said this would be used “to help providers better understand the WISeR process.”
Although CMS vendors say humans make the final approval decisions, doctors and their staff believe that artificial intelligence plays a large role in the process, and that denials can sometimes be the result of hallucinations caused by AI garbled or fabricated information.
One Arizona doctor, who was not authorized to speak by his clinic, recalled patients being denied chest or mid-back surgeries as ineligible. The patient required a neck injection. Mr. Webb, an Oklahoma radiologist, documented four times that his patients had no numbness, yet his WISeR application was rejected for numbness, which the reviewer’s interpretation ruled out spinal surgery.
Friese, CEO of Humata, said he had never heard of AI hallucinations.
This process also increases costs to government. As denials increase, so too do appeals against Medicare administrative contractors. The government pays contractors to process appeals, and Medicare’s Sutton acknowledged that the agency is “considering the potential for fluctuations in Medicare appeals volumes due to the WISeR program and its associated costs.”
According to a study published in 2025 by the National Association of Insurance Commissioners, 84% of commercial insurers already use AI tools, but consistently state that AI is not used to deny prior authorization requests.
Its use in Medicare risks creating friction and frustration in the program and imposing costs on beneficiaries. Miranda Yaber, a health policy researcher at the University of Pittsburgh who is studying the technology, said prior authorization would save insurers money by forcing patients to pay for wait time and inconvenience.
“People end up getting caught up in a lot of red tape and being put on hold or rerouted,” she says. She often wonders whether prior authorizations simply pass costs on, rather than saving patients or physicians money.
Some doctors involved in Medicare’s previous licensing experiment believe it is inevitable that it will expand beyond the small number of services that Washington officials believe are at risk of fraud.
“We all know that if this pilot project goes well, we’ll basically be able to get pre-approval for every procedure,” said Mary Clark, a family physician in Stillwater, Oklahoma. “If we can show that we can save money, that will be extrapolated and rolled out to other procedures in other states and multiple other things.”
In response to a question about whether CMS is considering expanding preclearance testing, Sutton said in a statement that “no changes are being considered at this time” to the list of services eligible for the WISeR program, “However, CMS continues to evaluate whether changes are warranted.”
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KFF Health News Southern Correspondent Lauren Saucer contributed to this report.
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