The Non-prophets

“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 specific expertise. AJ and Jonathan discuss personal experiences, highlighting frustrations with insurance companies’ arbitrary denials that delay essential treatments, turning healthcare into a bureaucratic struggle that often prioritizes profit over patient well-being.AJ recounts enduring unnecessary delay