This is how Evicore goes on-record to explain away its cost-savings results for insurers, as the only goal of the prior authorization process is to ensure the safe and effective delivery of medical care. This blood-boiling exposé uncovers its non-public-facing marketing strategy which has gained so many contracts with insurance companies it’s now a crucial determinant of the healthcare received by 1 in 3 Americans: for every dollar spent on EviCore, it will save the insurer three dollars on medical costs for its card-carrying members. What’s more, it uses artificial intelligence-driven algorithms to find mistakes and loopholes to flag certain prior authorization requests for potential denials, with thresholds for denial ratcheted up or down based on where it currently stands meeting cost-cutting promises for each contract. How is this legal, again…? Be advised to read this when your blood pressure can withstand it. | Miller, ProPublica 2024
