How EviCore Helps Health Insurers Deny Coverage by Outsourcing Medical Reviews
By
ceejayoz
18d ago· 22 min readenNews
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Summary
This investigative article exposes EviCore, a company hired by major health insurers like Aetna and UnitedHealthcare to conduct medical reviews and deny coverage for doctor-recommended treatments. The piece details how EviCore's business model profits from rejecting care, affecting patients ranging from a high school wrestler needing an MRI to a grandmother requiring cancer treatment. It reveals the hidden industry of third-party medical review firms that help insurers cut costs by overriding physicians' medical judgments.
Key quotes
· 3 pulledEvery day, patients across America crack open envelopes with bad news.
The insurance companies don't always make these decisions. Instead, they often outsource medical reviews to a largely hidden industry that makes money by turning down doctors' requests.
When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.
When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.
