Insurance Denials: Profit Over Patients in Healthcare Crisis
Submitted by MAGA
Posted 27 days ago
The pervasive grip of chronic insurance denials threatens the well-being of countless Americans, as highlighted by a recent investigation into the practices of EviCore, a company that plays a pivotal role in the coverage decision-making of major health insurers.
EviCore, owned by insurance giant Cigna, oversees prior authorization requests for over 100 million individuals, making critical decisions about their healthcare based on an algorithm dubbed by insider sources as “the dial.”
This software enables the company to manipulate approval rates by adjusting the criteria for review. When insurers pressure EviCore to cut costs, the dial can be fine-tuned to elevate the denial rates of doctors’ requests.
As evident in the case of Little John Cupp from Ohio, patients face dire consequences of these denial practices. After experiencing severe abdominal discomfort, Cupp’s necessary cardiac catheterization was denied not once, but twice, leading someone whose life hung in the balance to be deemed “not medically necessary.”
This is not an isolated incident; EviCore's algorithm is designed not for patient safety but for profit maximization, allowing the company to boast of a 15% increase in denial rates since it began operations.
While EviCore claims to employ industry guidelines grounded in quality and safety, the reality shows a startling pattern of making health care decisions based on what is financially beneficial to the company.
As patients grapple with rising insurance costs and deteriorating treatment access, leaders in the healthcare industry, including those at the American Medical Association, are beginning to voice their frustration.
The primary concern is that insurers, in their quest for profit, are prioritizing their bottom lines over the health and lives of their clients. This exploitative “denials-for-dollars” approach serves as a reminder of the rampant issues plaguing the modern healthcare system.
Despite admirable intentions behind the need for cost management and resource allocation, the tactics employed by EviCore and companies like it illuminate systemic flaws that leave patients in peril.
As leaders in Washington continue to prioritize health reform, it is crucial they address the actions of insurance companies that profit from denying care at the expense of American lives.
Now, more than ever, a collective call for accountability in the healthcare insurance industry is necessary to safeguard patient rights and ensure that access to medical care is not contingent on profit margins.
Sources:
propublica.org
infowars.com
bearingarms.com
EviCore, owned by insurance giant Cigna, oversees prior authorization requests for over 100 million individuals, making critical decisions about their healthcare based on an algorithm dubbed by insider sources as “the dial.”
This software enables the company to manipulate approval rates by adjusting the criteria for review. When insurers pressure EviCore to cut costs, the dial can be fine-tuned to elevate the denial rates of doctors’ requests.
As evident in the case of Little John Cupp from Ohio, patients face dire consequences of these denial practices. After experiencing severe abdominal discomfort, Cupp’s necessary cardiac catheterization was denied not once, but twice, leading someone whose life hung in the balance to be deemed “not medically necessary.”
This is not an isolated incident; EviCore's algorithm is designed not for patient safety but for profit maximization, allowing the company to boast of a 15% increase in denial rates since it began operations.
While EviCore claims to employ industry guidelines grounded in quality and safety, the reality shows a startling pattern of making health care decisions based on what is financially beneficial to the company.
As patients grapple with rising insurance costs and deteriorating treatment access, leaders in the healthcare industry, including those at the American Medical Association, are beginning to voice their frustration.
The primary concern is that insurers, in their quest for profit, are prioritizing their bottom lines over the health and lives of their clients. This exploitative “denials-for-dollars” approach serves as a reminder of the rampant issues plaguing the modern healthcare system.
Despite admirable intentions behind the need for cost management and resource allocation, the tactics employed by EviCore and companies like it illuminate systemic flaws that leave patients in peril.
As leaders in Washington continue to prioritize health reform, it is crucial they address the actions of insurance companies that profit from denying care at the expense of American lives.
Now, more than ever, a collective call for accountability in the healthcare insurance industry is necessary to safeguard patient rights and ensure that access to medical care is not contingent on profit margins.
Sources:
propublica.org
infowars.com
bearingarms.com
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