Medicare Will Require Prior Approval for Certain Procedures
August 28, 2025

(New York Times) – A pilot program in six states will use a tactic employed by private insurers that has been heavily criticized for delaying and denying medical care.
The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.
The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections. (Read More)