When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.
When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.
If you get denied for coverage for something you know is in your plan always ask for the name and credentials of whoever made the denial! If they are not an MD they are not supposed to make that call as that can be interpreted as practicing medicine (determining if someone gets treatment or not) without a license. Often insurance companies will back down if you assert that you need a medical professional to review the denial /your appeal of the denial. (YMMV/IANAL)
Be careful of this, though. They do have MDs on hand who will absolutely rubber stamp denials.