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.

“Congress and the public deserve a full understanding of the impact this program is having on our seniors and our health care system,” said Rep. Suzan DelBene on Monday at a news conference at the University of Washington Medical Center. The congresswoman has sponsored legislation to roll back the program.

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.

WISeR, rolled out in Washington and five other states, includes over a dozen procedures meant to treat back and neck pain, arthritis and incontinence, among other conditions.

Under the program, doctors in Washington say they’re now spending more time and resources seeking approvals, facing rejections and submitting appeals for procedures that they could previously schedule immediately. For some patients, the program means longer wait times for relief and medical care.

“It’s just making patients’ lives more miserable,” said Dr. Maheetha Bharadwaj, a urology resident at the University of Washington.

During her residency, Bharadwaj has met numerous patients who struggle with overactive bladders. Some of them are prescribed sacral nerve stimulation, a treatment that can significantly reduce the number of incontinence episodes they have each day.

But since the start of this year, Bharadwaj has seen multiple patients get denied treatment under the WISeR program. When faced with denials, doctors have to go through an appeals process that can take weeks to play out.

“I don’t want some AI program determining whether my patient, who is crying in front of me because she has several incontinence episodes a day, deserves a sacral nerve stimulator or not,” she said.

Rather than saving money, some doctors say that the WISeR program has simply shifted more work and costs onto their staff.

“We’re seeing longer approval times, blanket denials and growing administrative burdens on physicians and staff,” said Chris McMullen, a UW doctor who specializes in sports medicine and spine care. “Most importantly, we see patients left waiting in pain.”

He and his colleagues regularly perform epidural steroid injections, one of the procedures included in WISeR. Since the start of this year, the program has denied treatment to multiple patients, effectively overriding the clinical judgments of McMullen and other UW doctors.

CMS has also recently faced scrutiny for potentially launching the WISeR program without following proper procedure. In May, the Government Accountability Office determined that the program should have been submitted to Congress for review before it was implemented, which would have given lawmakers a chance to prevent it from taking effect.

CMS did not immediately respond to questions and a request for comment. This year, the agency told The Seattle Times that it was monitoring the program’s performance and would take “corrective action” if it created inappropriate barriers to care.

'Existential pain'

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 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.

Badalamente went to his spine specialist in February to see about getting another steroid injection. The pain had come back since his last shot in 2023, and it was starting to interfere with daily life. It hurt to sit for long periods, and he couldn’t stand without bending over.

Badalamente is also the primary caretaker for his wife, Patricia, a former nurse whom he met in 1965, while he was serving in the Air Force. The pain was getting in the way of his ability to help her.

“It isn't just an issue of physical pain,” he said. “It's also an existential pain.”

Little did he know, it would be months before he could get any relief.

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.

“It was going from one mechanism to another trying to cope with the issue,” he said.

Eventually Virtix approved the request for Badalamente’s epidural steroid injection. Badalamente finally got the procedure done in late April.

In response to a request for comment about delays experienced by Medicare patients in Washington, a spokesperson for Virtix wrote in an email on Monday that the company issues its decisions under the WISeR program within “a few days.” The email cited other potential reasons for delays, including cases where doctors don’t include all the necessary documentation in their initial requests, or when they don’t submit appeals promptly.

But doctors say that the appeals process itself is onerous.

Doctors usually have to submit more paperwork, while patients might have to undergo further evaluations. Sometimes, doctors have to participate in what are known as peer-to-peer reviews, which are phone calls with Virtix-employed physicians, in which they have to make the case that a procedure is necessary.

Some patients, tired of waiting, offer to pay for procedures themselves.

That’s what happened to Keith Magnuson, who was suffering from back pain earlier this year. His doctor recommended that he get an epidural steroid injection as part of his treatment plan. WISeR disagreed.

“Back and forth with denials the WISeR program and finally I offered to pay,” Magnuson recalled at Monday’s event. “I’m lucky I have enough money that I can afford that.”

He eventually got his procedure in April and is now pain-free.

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