Sep 18, 2026 · 7 min · 9 segments
One Medicare patient waited eighty-three days for their AI reviewer to answer. Run time: 7:10 In today's episode: Medicare's AI prior-auth pilot denied care, delayed one case 83 daysFDA final…
New documents obtained by the Electronic Frontier Foundation through a public records lawsuit show the problem ran deeper than one vendor.
One request sat unanswered for 83 days against a promised 72-hour turnaround.
Two vendors together denied nearly 6,000 requests in the pilot's first three months, and one of them, Vertix, denied more requests than it approved.
A vendor called Innovaxxer warned CMS weeks before launch that its software wasn't fully tested and that auto-approving everything was, in its own words, the only path available.
The financial fix built into the program barely bites.
A low quality score only cuts a vendor's payment by 5% to 10%.
Doctors describe patients crying at the bedside, waiting on answers that never come on time.
Signal, not noise.
This isn't a benchmark paper.
It's federal documents showing a live program denying and delaying real care, with a penalty too small to change vendor behavior.
New documents obtained by the Electronic Frontier Foundation through a public records lawsuit show the problem ran deeper than one vendor.
One request sat unanswered for 83 days against a promised 72-hour turnaround.
Two vendors together denied nearly 6,000 requests in the pilot's first three months, and one of them, Vertix, denied more requests than it approved.
A vendor called Innovaxxer warned CMS weeks before launch that its software wasn't fully tested and that auto-approving everything was, in its own words, the only path available.
The financial fix built into the program barely bites.
A low quality score only cuts a vendor's payment by 5% to 10%.
Doctors describe patients crying at the bedside, waiting on answers that never come on time.
Signal, not noise.
This isn't a benchmark paper.
It's federal documents showing a live program denying and delaying real care, with a penalty too small to change vendor behavior.
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