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EviCore's Algorithm: Denials for Dollars
Investigation reveals how EviCore, a healthcare company, uses algorithms to deny medical treatments, potentially harming patients.
English
United States
Us PoliticsHealthHealthcareEthicsInsuranceProfitAlgorithms
EvicoreCignaUnitedhealthcareAetnaBlue Cross Blue Shield
Barbara McanenyLittle John CuppChris CuppGail MillerDave Jones
- What is EviCore and how does its algorithm impact medical care?
- EviCore, a subsidiary of Cigna, uses an algorithm to review prior authorizations for medical treatments, often resulting in denials that delay or prevent necessary care.
- How does EviCore's algorithm work and what are the ethical concerns?
- The algorithm, adjustable by EviCore, can be manipulated to increase or decrease denial rates, influenced by contracts incentivizing cost-cutting for insurers. This raises concerns about objectivity and patient well-being.
- What are the broader implications of profit-driven models in prior authorization processes?
- While prior authorizations serve a purpose, the profit-driven model of companies like EviCore raises ethical and legal questions regarding patient care and the potential for manipulation of denial rates.
- What criticisms have been raised regarding EviCore's guidelines and their impact on patient care?
- Doctors and medical organizations have repeatedly criticized EviCore's guidelines as outdated and rigid, leading to inappropriate denials and delays in treatment, despite EviCore's claims of using evidence-based medicine.
- How does Little John Cupp's case illustrate the potential negative consequences of EviCore's practices?
- Little John Cupp's experience highlights the potential consequences of EviCore's practices; his delayed heart catheterization, due to denials, may have contributed to his fatal cardiac arrest.