I have a friend that has Blue Cross / Blue Shield for insurance, but her annual procedure that has always been approved, was denied last week by a evicore doctor, even though her doctor approved it. She now needs to wait 3-4 weeks for the appeal process.
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From chatGPT
People often express frustration or dislike for eviCore Healthcare, a company that provides utilization management services, because of the perceived obstacles it creates in obtaining timely medical care. Common complaints about eviCore include:
### 1. Delays in Care
- Prior Authorization Process: eviCore often requires prior authorization for procedures, tests, or treatments. Patients and providers complain that this process can take days or even weeks, delaying necessary care.
- Denials and Appeals: Initial denials of coverage for requested services lead to appeals, adding more time and stress.
### 2. Perceived Bureaucracy
- Complexity: Providers must submit detailed documentation to justify treatments, and the process is seen as unnecessarily cumbersome.
- Administrative Burden: Healthcare providers often spend significant time navigating eviCore's processes, which detracts from patient care.
### 3. Lack of Transparency
- Unclear Criteria: Patients and providers frequently cite a lack of transparency in how decisions are made and why services are denied.
- Difficulty Reaching Support: Reports of long wait times and unhelpful customer service exacerbate frustrations.
### 4. Patient Impact
- Financial Stress: Patients may be denied coverage for services they consider necessary, forcing them to pay out of pocket or forgo care.
- Emotional Toll: Repeated denials and delays can cause anxiety for patients dealing with serious or chronic conditions.
### 5. Provider Frustration
- Interference with Clinical Judgment: Many doctors feel eviCore's policies undermine their ability to make decisions in the best interest of their patients.
- Disruption to Workflows: Navigating preauthorization requirements consumes valuable time that could be spent treating patients.
### Why Does eviCore Exist?
Despite these criticisms, eviCore argues that its processes help control healthcare costs by reducing unnecessary or low-value care and ensuring treatments are evidence-based. However, the tension lies in balancing cost containment with timely and effective patient care.
The dissatisfaction often stems from a perception that this balance disproportionately favors cost savings over patient outcomes.
I don't want to speak for OP but it's common knowledge that evicore is a key player in denying claims
https://scai.org/evicore-helps-insurers-deny-coverage-care-prior-authorizations
Care to explain this one?
There’s no need to yell.