Customer ReviewsforeviCore healthcare

Sham organization run by thugs. The name of the game is to hold on to members premiums as long as possible to make money in investments. eviCore is organized crime, like the rest of the companies involved in healthcare. I have a well documented health issue, which my insurance company has been paying claims on for nearly 10 years. I have moved and changed doctors, and need a current MRI to continue much needed treatment. The request was denied out of hand by eviCore. I was told they do not look at a patient's history, they don't need to. That "this is the process" and we are hostage to it. This is criminal. Absolutely nothing short of a scam to hold on to the money as long as possible. I asked for the name of the person who denied my claim and what their credentials are, and was told I could not have that information. SCAM SCAM SCAM and we are all hostage to them

The member's health plan has engaged eviCore to perform initial reviews of certain clinical procedures. The policies and procedures that govern eviCore’s Clinical Certification Program are subject to the quality standards established by external regulatory bodies such as the State Department of Health, The National Committee for Quality Assurance (NCQA) and URAC. Panels of physicians representing the appropriate range of specialties establish the clinical policies and medical necessity criteria, which are reviewed annually.

eviCore determinations are based on a comparison of the clinical information submitted to support the requested service and the relevant policy and medical appropriateness. Certification reviews are conducted on the basis of information provided and authorizations are issued for those services consistent with the criteria.

The member’s health plan does not delegate member complaints to eviCore. When the health plan does not delegate member complaints to eviCore, we are contractually restricted from responding to the member once a complaint has been filed. However, eviCore provides all case documentation to the health plan as requested, including but not limited to, the clinical information received, clinical criteria used and decision rationale.

When a member complaint has been received, eviCore forwards the complaint to the health plan and provides all documentation as requested, the health plan then addresses the complaint with the member.

This complaint has been forwarded to the health plan as per the process the health plan has implemented. The member can also contact their health plan for additional information. In addition, the member or their Provider can contact eviCore to discuss their case by referring to the non-certification letter received and via the contact number provided therein.