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1 week ago
https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?campaign_id=190&emc=edit_ufn_20250829&instance_id=161505&nl=from-the-times®i_id=122976029&segment_id=204873&user_id=b25c5730c89e0c73f75709d8f1254337
Medicare will pilot a prior authorization program using AI to review certain procedures, potentially saving billions but raising concerns about access to care and privatization.
AI Extracted Information
Automatically extracted metadata and content analysis.
- AI Headline
- Medicare Will Require Prior Approval for Certain Procedures
- Simplified Title
- Medicare Implements Prior Authorization Pilot Program
- AI Excerpt
- Medicare will pilot a prior authorization program using AI to review certain procedures, potentially saving billions but raising concerns about access to care and privatization.
- Subject Tags
-
Medicare Healthcare Prior Authorization Artificial Intelligence Government Policy Health Insurance
- Context Type
- News
- AI Confidence Score
-
1.000
- Context Details
-
{ "tone": "informative", "perspective": "neutral", "audience": "general", "credibility_indicators": [ "expert_quotes", "data_cited", "named_sources" ] } - Tone
- analytical
- Perspective
- neutral
- Audience
- general
Source Information
Complete details about this source submission.
- Domain
- nytimes.com
- Site Name
- The New York Times
- Section
- Health
- Publisher
- The New York Times Company
- Author
- Reed Abelson, Teddy Rosenbluth
- Published Date
- August 28, 2025 at 12:00 AM
- Overall Status
-
Pending
- Submitted By
- Donato V. Pompo
- Submission Date
- August 29, 2025 at 4:41 PM
- Metadata
-
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Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities.", "simplified_text": "Centers for Medicare and Medicaid Services plans pilot program involving review process for traditional Medicare.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Regulation" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3d6-b34c-4758-ada9-aeca3618b6eb", "text": "The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.", "simplified_text": "Pilot program would start in six states next year including Oklahoma.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Policy" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3d7-af69-48ce-b689-08995fb72789", "text": "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.", "simplified_text": "Federal government plans to hire private companies to use AI to determine patient coverage for some procedures.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Technology" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3d8-dd94-4cd3-b8eb-98b9fc60392f", "text": "The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims.", "simplified_text": "AI companies overseeing program would have financial incentive to deny claims.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Finance" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3d9-d39a-4d52-846d-5878964277f9", "text": "Medicare plans to pay them a share of the savings generated from rejections.", "simplified_text": "Medicare plans to pay AI companies share of savings from rejections.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Finance" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3da-d05b-4fb5-8e4a-207abbf11f6d", "text": "The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients.", "simplified_text": "Government said AI screening tool would focus on about a dozen costly procedures of little benefit to patients.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Technology" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3db-d3a9-40ff-b637-0b7042517695", "text": "Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.", "simplified_text": "Procedures include devices for incontinence control cervical fusion steroid injections nerve stimulators diagnosis and treatment of impotence.", "claim_maker": "The author", "claim_subject_tags": [ "Health" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3dc-ce3b-494c-b92b-f4a7e65091c3", "text": "Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.", "simplified_text": "Abe Sutton said government would not review emergency services or hospital stays.", "claim_maker": "Abe Sutton", "claim_subject_tags": [ "Health", "Regulation" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3dd-babe-44ee-8fa8-f44c9138d6fe", "text": "The model is expected to save several billions of dollars over the next six years, although it could save more if it were expanded.", "simplified_text": "Model is expected to save several billions of dollars over next six years.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Finance" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3de-a882-4cd8-af5d-77d12b50f0cf", "text": "People enrolled in traditional Medicare who live in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington State will be included in the experiment, which is expected to start in January and last for six years.", "simplified_text": "People in traditional Medicare in Arizona New Jersey Ohio Oklahoma Texas Washington State will be included in experiment.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Policy" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3df-ab12-45f7-8d5c-6a2ebc684ba5", "text": "Private plans under Medicare Advantage have become increasingly popular, with a little more than half of older Americans and people with disabilities eligible for the program and some 34 million enrolled.", "simplified_text": "Private plans under Medicare Advantage have become increasingly popular with some 34 million enrolled.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Finance" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3e0-9e7b-4583-a6b4-c7fa4a650c79", "text": "The American Medical Association wrote in a letter that doctors view prior authorization \u201cas one of the most burdensome and disruptive administrative requirements they face in providing quality care to patients.\u201d", "simplified_text": "American Medical Association wrote doctors view prior authorization as burdensome and disruptive.", "claim_maker": "American Medical Association", "claim_subject_tags": [ "Health", "Regulation" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3e1-897e-4575-81dd-9b2fad5cb6ae", "text": "Most patients who appeal are successful, but a vast majority never appeal.", "simplified_text": "Most patients who appeal are successful but vast majority never appeal.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Legal" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3e2-78e4-4d91-911f-ff4ed95f901d", "text": "The agency came under scrutiny earlier this year for spending billions of dollars on expensive \u201cskin substitutes\u201d of dubious value.", "simplified_text": "Medicare agency came under scrutiny for spending billions on expensive skin substitutes of dubious value.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Finance" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3e3-7465-4d62-8161-814d48a83603", "text": "The pilot program would require patients to seek prior authorization before getting a skin substitute.", "simplified_text": "Pilot program would require patients to seek prior authorization before getting skin substitute.", "claim_maker": "The author", "claim_subject_tags": [ "Health", "Policy" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3e4-6b7c-4fd7-abe5-31de0ac5de70", "text": "Government officials said that any denials would be done by \u201can appropriately licensed human clinician, not a machine.\u201d", "simplified_text": "Government officials said denials would be done by licensed human clinician not a machine.", "claim_maker": "Government officials", "claim_subject_tags": [ "Health", "Regulation" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null }, { "uuid": "9fc8a3e5-68fe-413b-b64d-be12f03440da", "text": "Mr. Sutton also emphasized that the government could penalize companies for inappropriate decisions.", "simplified_text": "Mr Sutton emphasized government could penalize companies for inappropriate decisions.", "claim_maker": "Mr. Sutton", "claim_subject_tags": [ "Health", "Regulation" ], "confidence": 1, "context_type": "News Article", "similarity_found": false, "linked_to": null, "similarity_score": null } ], "improved_author": "Reed Abelson and Teddy Rosenbluth", "suggested_reeval_at": "2026-08-29 12:37:00" } } - Database ID
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- UUID
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- Submitted By User ID
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- Created At
- August 29, 2025 at 4:41 PM
- Updated At
- September 2, 2025 at 7:23 PM
- AI Source Vector
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Vector length: N/A
- AI Extraction Metadata
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Medicare Will Require Prior Approval for Certain Procedures By Reed Abelson and Teddy Rosenbluth Aug. 28, 2025 Like millions of older adults, Frances L. Ayres faced a choice when picking health insurance: Pay more for traditional Medicare, or opt for a plan offered by a private insurer and risk drawn-out fights over coverage. Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensified after the murder of a UnitedHealthcare executive last December. Ms. Ayres, a 74-year-old retired accounting professor, said she wanted to avoid the hassle that has been associated with such practices under Medicare Advantage, which are private plans financed by the U.S. government. Now, she is concerned she will face those denials anyway. The Centers for Medicare and Medicaid Services plans to...
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Claims from this Source (20)
All claims extracted from this source document.
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Simplified: Pilot program in six states will use tactic criticized for delaying and denying medical care.
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Simplified: Private insurers often require review process resulting in denial or delay of essential treatments.
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Simplified: Prior authorization has drawn public scrutiny intensified after UnitedHealthcare executive murder last December.
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Simplified: Centers for Medicare and Medicaid Services plans pilot program involving review process for traditional Medicare.
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Simplified: Pilot program would start in six states next year including Oklahoma.
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Simplified: Federal government plans to hire private companies to use AI to determine patient coverage for some procedures.
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Simplified: AI companies overseeing program would have financial incentive to deny claims.
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Simplified: Medicare plans to pay AI companies share of savings from rejections.
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Simplified: Government said AI screening tool would focus on about a dozen costly procedures of little benefit to patients.
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Simplified: Procedures include devices for incontinence control cervical fusion steroid injections nerve stimulators diagnosis and treatment of impotence.
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Simplified: Abe Sutton said government would not review emergency services or hospital stays.
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Simplified: Model is expected to save several billions of dollars over next six years.
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Simplified: People in traditional Medicare in Arizona New Jersey Ohio Oklahoma Texas Washington State will be included in experiment.
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Simplified: Private plans under Medicare Advantage have become increasingly popular with some 34 million enrolled.
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👤 American Medical Association 📋 News Article 🏷️ Health , Regulation 🆔 9fc8a3e0-9e7b-4583-a6b4-c7fa4a650c79Simplified: American Medical Association wrote doctors view prior authorization as burdensome and disruptive.
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Simplified: Most patients who appeal are successful but vast majority never appeal.
-
Simplified: Medicare agency came under scrutiny for spending billions on expensive skin substitutes of dubious value.
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Simplified: Pilot program would require patients to seek prior authorization before getting skin substitute.
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Simplified: Government officials said denials would be done by licensed human clinician not a machine.
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Mr. Sutton also emphasized that the government could penalize companies for inappropriate decisions.1.000Simplified: Mr Sutton emphasized government could penalize companies for inappropriate decisions.