Washington seniors are facing longer waits and denied treatments under a new federal pilot program that uses artificial intelligence to review Medicare procedure requests. The program, called WISeR, is designed to reduce what officials describe as wasteful or low-value medical services. But doctors, hospitals, and lawmakers in Washington state say it is instead slowing care and putting patient health at risk.
The six-year WISeR program began in January in Washington and five other states. It requires prior authorization for certain medical procedures under traditional Medicare. These include common treatments such as steroid injections for pain, knee arthroscopy, spinal procedures, and some skin-related medical products. Until now, most traditional Medicare patients did not need prior approval for these services.
The program is run through private companies selected by the Centers for Medicare and Medicaid Services. In Washington, the contractor is Virtix Health, based in Arizona. These companies are financially rewarded based on how much spending they reduce. In practice, critics say this creates an incentive to deny medical procedures.
U.S. Representative Suzan DelBene, a Washington Democrat, said the system is harming patients. She argues that seniors are experiencing delays in care and worsening health while waiting for approvals. She has also called for the program to be repealed in Congress, describing it as a system that allows companies to profit from care denials.
Hospitals across Washington report significant delays since WISeR began. According to the Washington State Hospital Association, some patients are now waiting two to four times longer for approvals. At the University of Washington Medicine system, approval times have increased from just a few days to as long as three weeks in some cases.
Health care workers say these delays are having real consequences. Patients living with chronic pain or serious conditions are often left waiting without treatment. Advocates warn that these delays can lead to worsening symptoms and reduced quality of life.
Hospital administrators also report technical and workflow issues with the system. Some say the online platform used by Virtix is designed for individual users rather than hospital teams. This makes it difficult for staff to track and continue patient cases efficiently, especially when multiple employees are involved in a single claim.
Medical groups also question whether proper physician-level reviews are actually happening when claims are denied. Doctors in Washington say some denials appear inconsistent with standard medical practice. They argue that if qualified physicians were properly reviewing cases, many of the denials would not occur.
Virtix Health has acknowledged early challenges in running the program, saying that implementation has affected hospital workflows. The company says this is expected in a pilot program and that adjustments are being made. However, hospitals and physicians say the problems go beyond normal start-up issues.
Some cases highlight deeper concerns. Doctors report situations where procedures were approved by the AI system but later denied again by other Medicare contractors responsible for payment processing. This has created confusion for both patients and providers.
The broader debate over AI in health care is also growing. Medicare Advantage programs already use automated systems for claim reviews, and critics say these systems have led to high denial rates. Studies show many denials are overturned on appeal, but most patients do not pursue appeals, leaving care decisions unchanged.
Lawmakers such as Senator Patty Murray and Senator Maria Cantwell have raised concerns that AI-driven prior authorization may expand bureaucratic barriers in traditional Medicare. They argue that medical decisions should be made by doctors, not algorithms or cost-saving systems tied to denial rates.
The federal Government Accountability Office has also reviewed the WISeR program, ruling that it required congressional oversight before implementation. Lawmakers have since introduced measures to stop or reverse the program, but those efforts face political obstacles.
Supporters of the program argue that it is aimed at reducing unnecessary medical spending and improving efficiency in Medicare. They say oversight mechanisms are in place, including requirements for medical professional review of denied claims. However, critics remain unconvinced that these safeguards are working effectively in practice.
As the debate continues, Washington hospitals say they are already seeing the effects on patient care. With longer waits, increased paperwork, and uncertainty in approvals, many providers fear the system is shifting focus away from patients and toward administrative processes.
For now, the future of the AI Medicare review program remains uncertain. But in Washington state, the impact is already being felt by seniors who are waiting longer for care they say they urgently need.
