Reporting Highlights
- Dialing for Dollars: America’s largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people.
- “The Dial”: EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials.
- Lucrative Deals: Some EviCore contracts are based on how deeply the company can reduce spending on medical procedures. It tells insurers that it can provide a 3-to-1 return on investment.
Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.
But 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 for payments, known as prior authorizations. Call it the denials for dollars business.
The biggest player is a company […]
Although this is an excellent article detailing the abuse the American public has suffered under the banner of “Managed Care” what gives anyone the conception that Democrats will do anything about it? Managed care has been doing this in most of the United States for over 40 years. The Democrats have had plenty of opportunity to fix the problem and they have failed – miserably. Want to change the outcomes? Then you have to change the structure. Think and vote outside the box.
Let’s be real—-nearly every capitalist corporation is bound by greed!!! Medicine is profit-making and that’s all that matters. Education now is based on profit given all the charter schools. Even grocery stores keep raising their prices.
Greed! Greed! Greed!