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Podcast: The Non-Prophets
Episode: Not Medically Necessary
Description: “Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for CarePro Publica, By T. Christian Miller, on Oct 23, 2024https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations The panel delves into the complexities and pitfalls of the U.S. healthcare system, particularly the insurance industry's reliance on algorithms and outsourced decision-making to approve or deny pre-authorized medical claims. They examine the unsettling trend of companies like Evicore, which utilize algorithms to deny claims based on perceived discrepancies, leaving critical decisions to doctors who have limited time and often lack specifi...