Bill Curry, 65, raises cattle on the same land in rural Oklahoma once owned by his father and generations before him. Each quarter, for several years, he has made the 2\u00bd-hour drive to Oklahoma City for an epidural in his spine to treat his back pain.<\/p>\n
But this year, because of a new Medicare program, Curry has traveled a little more often.<\/p>\n
In February, during one trip, he was told unexpectedly that he needed preapproval for the procedure. Then he went again a month or so later to get the injection, for a total of 10 hours on the road. His clinic wanted him to come in a third time, which they had never asked of him before. That appointment was \u201cjust to fill out a piece of paper to tell them how you feel again,\u201d Curry said, so he hasn\u2019t gone.<\/p>\n
In January, Oklahoma became one of six states to begin a pilot program testing the use of preapprovals<\/a> in traditional Medicare, the federal health insurance program for people 65 and older or with disabilities. Medicare had previously eschewed the practice \u2014 also known as prior authorization \u2014 which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions.<\/p>\n Epidurals like Curry\u2019s are among 13 medical services subject to the new program because the Trump administration says they\u2019re prone to fraud or misuse. Powered by artificial intelligence, the program \u2014 called the Wasteful and Inappropriate Service Reduction Model, or WISeR \u2014 is intended to save the federal government money and protect patients from potentially unsafe or unneeded care.<\/p>\n Yet early reviews from Oklahoma and the other pilot states \u2014 Arizona, New Jersey, Ohio, Texas, and Washington \u2014 suggest WISeR\u2019s rollout has not been smooth. Patients, doctors, and other healthcare professionals who spoke with KFF Health News say the effort has created confusion, errors, long wait times, and stress. Some described the rollout as \u201chorrendous\u201d and say people enrolled in Medicare in the pilot states are now getting ensnared in the same red tape as those with private insurance.<\/p>\n One key concern is that it all happened too hastily. WISeR was announced in June 2025<\/a> and launched in mid-January.<\/p>\n That was \u201cquicker than normal\u201d for the federal government, said Todd Baker, who recently stepped down as CEO of the Ohio State Medical Association. Doctors \u201cjust sort of had to figure it out,\u201d added Jeb Shepard, director of policy at the Washington State Medical Association.<\/p>\n Government contractors have also acknowledged the rapid pace. \u201cWe\u2019ve had an aggressive rollout from the time of being notified to going live,\u201d said Jeremy Friese, CEO of Humata Health, the vendor for Oklahoma. Tech executives servicing other states have said they were still adding features to their products in the spring.<\/p>\n Abe Sutton, director of the Center for Medicare and Medicaid Innovation, which is administering the program, didn\u2019t comment on the rollout schedule. But he said in a statement that the goal of these reforms is to ensure that prior authorization is efficient, fast, and streamlined.<\/p>\n \u201cThe model aims to reduce inappropriate care without delaying appropriate care,\u201d he said.<\/p>\n Mehmet Oz, the leader of the Centers for Medicare & Medicaid Services, told NewsNation in December<\/a> that they were \u201crolling out some prior authorization on abused practices.\u201d<\/p>\n \u201cThe purpose of these is not to deny care,\u201d Oz continued. \u201cIt\u2019s to make sure you get the care you need and deserve, not the care some unscrupulous doctor wants to use on you.\u201d<\/p>\n![\"Newsletter](\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\"){kind=icon}
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