Medicare AI prior-auth pilot reportedly delaying care for Washington seniors

A CMS AI-driven prior authorization pilot for Medicare Advantage plans in Washington state is causing significant care delays, according to a report cited by Senator Maria Cantwell. The program uses automated systems to review and deny requests, with providers reporting increased administrative appeals and slower patient access to services. This follows broader industry concerns about opaque AI decision-making in utilization management. For practices with Medicare Advantage patients in Washington, expect longer resolution times on auth requests flagged by the system. Document all clinical rationale thoroughly and initiate appeals immediately upon denial to protect patient care timelines and revenue.