The Seattle Times is reporting that for months, Medicare patients in Washington have struggled with delays and denials for medical treatments due to a new program that uses artificial intelligence to review care.
Now, patients and their doctors are fed up and demanding changes. Lawmakers scrutinizing the program want to see it overhauled.
At the start of 2026, the Centers for Medicare and Medicaid Services launched an AI-enabled program to evaluate certain medical procedures before doctors can use them to treat patients. Called the Wasteful and Inappropriate Services Reduction program, or WISeR, the initiative is aimed at reducing unnecessary and costly medical treatments.
The price of denial can be months of suffering.
Richard Badalamente, 88, has experienced intermittent back pain for more than a decade.
When it flares up, the pain typically shoots from his lower back down his left side, through his buttock, through his leg and into his big toe.
For relief, Badalamente has been getting epidural steroid injections since 2014. The procedure is straightforward: His doctor injects a steroid into a small area around his spine, and this typically eliminates pain for an average of two years in Badalamente’s experience.
“Having the epidural is a big help,” he said, in an interview earlier this month.
Previously, Badalamente’s doctors followed the standard Medicare reimbursement process. First, they’d give him the injection, and then they’d apply for Medicare payment.
But under WISeR, his doctors must now first get Medicare approval through a third-party party tech company called Virtix Health. If they get approval, they can go forward with the procedure. But if they provide treatment without prior approval, they risk not getting paid. Virtix earns a percentage of the money it saves Medicare.
His doctor submitted a request for the procedure to Virtix in early February, according to Badalamente’s timeline of events. He later learned that Virtix denied the request, which meant the request needed to be re-submitted for an appeal.
For the next two months, Badalamente was stuck in a loop of waiting and following up with his doctor for updates. Meanwhile, his pain got progressively worse.
He started using a cane to get around, then two canes, then a walker. He stuck a pain patch on his lower back for relief, and when that wasn’t enough anymore, he started taking 500 milligrams of Tylenol, four times per day. -- nordy
Sure. Who cares about an eighty-eight-year-old pensioner being in terrible pain and losing his mobility?
Months ago, when I first heard AI was going to be used to make health care decisions, the thought made me cringe. This is exactly the sort of thing I foresaw - the sort of thing any human with a halfway working brain could have foreseen. It's an obscenity. And it is designed to punish and cull the worthless yet expensive elderly and disabled. I hope this report ultimately results in that particular AI, and the company that employs it, being out of a job!
Unholy Moly!! This MUST be stopped. I completely agree with Cat, that I have long been concerned about the use of AI in decision making, especially in health care!!
I thought of that too, W.A.. I think it'd both. My nephew's wife used to work for an insurance company, processing claims. She said there were so many ways that insurance companies try to make money and a big one is simply denying claims the first time they are filed. She was one of the good, moral people in the mix, doing all she could to get claims approved the first time around. And there are ways they can do that! But a system programmed to deny wouldn't have the compassion or moral grounding to try to get claims approved.
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DeleteThe Seattle Times is reporting that for months, Medicare patients in Washington have struggled with delays and denials for medical treatments due to a new program that uses artificial intelligence to review care.
ReplyDeleteNow, patients and their doctors are fed up and demanding changes. Lawmakers scrutinizing the program want to see it overhauled.
At the start of 2026, the Centers for Medicare and Medicaid Services launched an AI-enabled program to evaluate certain medical procedures before doctors can use them to treat patients. Called the Wasteful and Inappropriate Services Reduction program, or WISeR, the initiative is aimed at reducing unnecessary and costly medical treatments.
The price of denial can be months of suffering.
Richard Badalamente, 88, has experienced intermittent back pain for more than a decade.
When it flares up, the pain typically shoots from his lower back down his left side, through his buttock, through his leg and into his big toe.
For relief, Badalamente has been getting epidural steroid injections since 2014. The procedure is straightforward: His doctor injects a steroid into a small area around his spine, and this typically eliminates pain for an average of two years in Badalamente’s experience.
“Having the epidural is a big help,” he said, in an interview earlier this month.
Previously, Badalamente’s doctors followed the standard Medicare reimbursement process. First, they’d give him the injection, and then they’d apply for Medicare payment.
But under WISeR, his doctors must now first get Medicare approval through a third-party party tech company called Virtix Health. If they get approval, they can go forward with the procedure. But if they provide treatment without prior approval, they risk not getting paid. Virtix earns a percentage of the money it saves Medicare.
His doctor submitted a request for the procedure to Virtix in early February, according to Badalamente’s timeline of events. He later learned that Virtix denied the request, which meant the request needed to be re-submitted for an appeal.
For the next two months, Badalamente was stuck in a loop of waiting and following up with his doctor for updates. Meanwhile, his pain got progressively worse.
He started using a cane to get around, then two canes, then a walker. He stuck a pain patch on his lower back for relief, and when that wasn’t enough anymore, he started taking 500 milligrams of Tylenol, four times per day. -- nordy
Sure. Who cares about an eighty-eight-year-old pensioner being in terrible pain and losing his mobility?
DeleteMonths ago, when I first heard AI was going to be used to make health care decisions, the thought made me cringe. This is exactly the sort of thing I foresaw - the sort of thing any human with a halfway working brain could have foreseen. It's an obscenity. And it is designed to punish and cull the worthless yet expensive elderly and disabled. I hope this report ultimately results in that particular AI, and the company that employs it, being out of a job!
Unholy Moly!! This MUST be stopped. I completely agree with Cat, that I have long been concerned about the use of AI in decision making, especially in health care!!
DeleteI don't know enough to say, but I suspect the problem is not AI but the fact that Virtix has a financial incentive to deny care.
DeleteI thought of that too, W.A.. I think it'd both. My nephew's wife used to work for an insurance company, processing claims. She said there were so many ways that insurance companies try to make money and a big one is simply denying claims the first time they are filed. She was one of the good, moral people in the mix, doing all she could to get claims approved the first time around. And there are ways they can do that! But a system programmed to deny wouldn't have the compassion or moral grounding to try to get claims approved.
Delete