The algorithm behind health insurance denials
Update: 2024-11-21
Description
Some of the biggest health insurers in the country are turning to an algorithm to help determine if a medical claim will be approved. That’s according to a recent investigation led by ProPublica into EviCore, a contractor used to outsource prior approval requests for much of the insurance industry. The investigation found that EviCore tweaks an algorithm to increase the likelihood those claims will be denied, which means lower costs for insurers but more patients losing access to potentially lifesaving care. Marketplace’s Meghan McCarty Carino spoke to ProPublica’s T. Christian Miller, who co-reported this story.
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