ProPublica

“Not Medically Necessary”: Inside the Company Helping America’s Biggest #Health Insurers Deny Coverage for Care
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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.

https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations

#News #Insurance #Algorithm #AI #Healthcare

“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care

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.

ProPublica
Oct 23, 2024 at 6:07pmWeb
Show threadProPublicaOct 23, 2024

Our "Uncovered" series has more on how the #insurance industry denies coverage to #patients.

One of the stories describes how Cigna #doctors reject patients' claims without opening their files. "We literally click and submit," one former company doctor said. 👇

#News #Healthcare #Health

https://propub.li/4dXhXs3

How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said.

ProPublica
Show threadProPublicaOct 23, 2024

👉 Remember: You have a right to find out why your health insurer denied your claim. We built a tool to help you: https://propub.li/3Uj4ZO8

#Health #Insurance #Healthcare #Journalism #News

Claim File Helper

You likely have the right to access records that explain why your insurer denied your claim or prior authorization request. Use ProPublica’s free tool to generate a letter requesting your claim file from your health insurance company.

ProPublica
Show threadmrjonnoOct 23, 2024
@ProPublica S
@KimSJ
Are we surprised when profit is a motive?
My last job was to work at a hospital trust in IT. Total shambles and Saudi Arabia were voted top in IT initiative when they kill folks directly and indirectly to pollute with hydrocarbons.
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Never mind nursing. AI has a place in medicine, but not in general.
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Show threadsamiamsamOct 23, 2024

@ProPublica

#fuckers

Show threadTwotiredOct 23, 2024
@ProPublica Are you sure you didn’t leave out an “L” in the company’s name?
Show threadKING of PDXOct 23, 2024
@Twotired @ProPublica LOLOLOL😂​
Show threadRigantonaOct 23, 2024
@ProPublica The United States needs universal healthcare. We are literally killing people for money. It's shameful and disgusting.
Show threadMichael BuschOct 26, 2024

@Rigantona @ProPublica Under universal healthcare systems; patients may still need to argue for the care they need being covered.

But at least there is only one system to argue with.

Show threadSimonoidOct 23, 2024
@ProPublica a medical insurance company named themselves evicore? On purpose? That's just one letter short of evilcore 🤷
Show threadSamhain NightOct 23, 2024
@ProPublica Someone should sue the MFs for manslaughter.
Show thread⁂Krafty⁂ #NoKingsOct 24, 2024
@ProPublica Evilcore? Seriously? 😂
Show threadBrian OOct 24, 2024

@ProPublica After reading this article (and many others on the state of modern American healthcare) I have deep cynicism toward the idea that this company’s business model. They claim that their practices both elevate the overall level of care *and* save/make money. Because of course they do—they need to sleep at night.

However, … (1/2)

Show threadRozzychanOct 24, 2024

@ProPublica

Is it #Evicore or #Evilcore?

Show threadRicoOct 24, 2024
@ProPublica Sad but not really a surprise. In fact, this is what they’re supposed to do. You have to squeeze as much profits for your shareholders (these are the true beneficiaries—patients and health workers be damned) as possible. These are profit making enterprises. They are not there to help you. If they do, it’s incidental.