Private Health Insurers Use AI to Approve or Deny Care. Soon Medicare Will, Too.

The federal government will pilot an artificial intelligence program in Medicare to expand prior authorization, a process requiring insurance approval before certain procedures. Starting January 2026 in six states, the WISeR program aims to reduce low-value services and curb waste, targeting procedures like knee arthroscopy and nerve stimulators.

While AI may streamline approvals, experts caution it could delay or block care, raising patient safety and equity concerns. Medicare asserts human clinicians will review decisions and safeguards will prevent inappropriate denials. The pilot highlights the growing role of AI in healthcare oversight and the ongoing balance between cost containment and access to care. Read more from NBC news here.