The article discusses the practices of EviCore, a company that reviews medical claims for insurance companies, and the allegations that it prioritizes profits over patient care. EviCore is accused of denying or delaying necessary medical treatments to save costs for insurers, potentially putting patients at risk. The article cites cases where patients experienced significant harm or even death due to EviCore’s denials. Critics argue that EviCore’s financial incentives create a conflict of interest, as it profits from denying claims. The company defends its practices, stating that it follows evidence-based guidelines and aims to prevent unnecessary or inappropriate care. However, the article raises concerns about the lack of transparency and oversight in the utilization review industry, and the potential for patient harm when profit motives take precedence over medical necessity.
Source: https://www.cnn.com/2024/11/07/health/evi-care-insurance-company-denials-propublica/index.html