Eetna, picked one of the most incompetent or degenerate companies to review service request. They basically denied a simple and cheap CT scan request from the doctors for generic investigative workups trying to figure out what's causing a illness unless I can prove a history of a illness. So, other words you have to be pre diagnosed by somebody else to seek a diagnoses. I've dealt with this before but nowhere on the level of evicore, most of the time it's foreigners reviewing our medical information and making decisions which should be illegal. How is this even allowed in medicine today? I tell you, I can almost guarantee these are foreigners reviewing these authorization request and have zero educational or other qualifications to make these decisions. Incompetent but cheap. Right Aetna? I think, based the vast horrific reviews here, we take this to the attorney general at the federal level. What they are doing is criminal. Yelp, you need to put scale rating in so we can provide negative ratings. evicore would get a -3 at least. read more

Got denied for an mri I need from an injury. Company has 1 billion in profits from denying hard working Americans. Government needs to shut this thing down. Medical companies seeking that much profit from denying sick people is SICK! read more

They handle the pre-authorization for Aetna and they denied my sleep study because I worked my ass off and got to the point where I don't have comorbidities so they won't approve the lab study... nevermind that it's a split study that has retitration as part of it and that can't be DONE IN A HOME STUDY! read more

The absolute worst company there is. Zero empathy, incompetent customer service reps, beyond delayed turn around time for approval of prior authorizations. For three business days my prior authorization sat on the medical review desk "the last step". I went to the ER because I got fed up with waiting. So much for paying your monthly insurance premium. THEY DO NOT CARE. They are just as bad as Cigna, the company that owns them. If I had a choice I would never use this company again. read more

They canceled my preauthorization by accident because they "thought" I didnt need authorization, which I did need. 9 days later they made my Dr. resubmit everything and start over. However, they erased the prior information of my cancelation/expiration and told me that my dr. never sent it in. However, I took screenshots of everything and their answer was OH thats weird that it was erased. They are AWFUL and incompetent. They made up a different story every time I called. Still waiting 16 days later for a simple ankle MRI so I can start PT. HORRIBLE, BCBS needs to do better than hiring an incompetent company. read more

Evicore is responsible for reviewing and approving medical procedures for insurance companies. I have cancer. So far they have denied a CTScan and Chemotherapy. My oncologist has to jump through hoops to get the most basic cancer treatments approved. Honestly I think their role is to deny coverage out of the gate on first request. They inform you by an automated dialer call because they don't want any human contact. Evicore is owned by Cigna and I believe it is a scam to reduce the costs of treatment for the participating for profit insurance companies. My insurance company Jefferson Health Systems uses Evicore. USA health insurance coverage is managed by for profit corporations. What could go wrong? My question: is the Evicore doctor who reviewed the request for my chemotherapy an actual oncologist or even a doctor at all? read more

(True name is evilCore!) I sit idly by waiting for approval from this company regarding my pain management doctor and a procedure of using imaging to help guide a needle to a problem nerve in my spine, which affects how I walk. Everything past the point in my spine, all the way down to my toes, is affected by the inflammation of the nerves coming out of my spine, and knees and feet are affected and showing pain that could be misdiagnosed as other problems. I went to my doctor outside our normal appointment schedule, at the direction of my PCP, because of extreme pain (read: it really hurts! A LOT!). Then eviCore turns down the procedure, stating not enough evidence. So 15 years of issues including being placed on permanent disability isn't enough? I've had MRI's, CT Scans and X-rays throughout the years and they turn this down? The worst part of this, yes, we can appeal, but it's now been almost six weeks since the problem started, and here I sit, STILL in pain, decided by A.I. (really?) that it's not "medically necessary"??? This is WRONG, and as I read of other, more serious cases where this has happened, it becomes clear that over 100 insurance companies who use this "service" (Aetna, Cigna, United Healthcare, etc.) do so to get out of paying for services. So why are we giving them money just for some damned computer farm to help them skirt out of care? They should remove the word "Healthcare" from their name, they don't deserve it! Congress should enact laws to stop this practice, and I'll be writing my representatives! read more

I called EviCore the company that does UR for Cigna. I spoke with Ray R. Who was rude and confrontational from beginning to end. I saw an orthopedist for my hip issue and the utilization review was completed by a neurologist. The quality of care with eviCore is horrible, they just dont care. They want me to stay in pain for 6 weeks before authorizing a simple MRI. This company and Cigna are the worst!!!Blue Shield is the best! read more

Worse customer service ever. Not sure why any insurance company would use them as a third party. I will be filling complaints with my insurance company. They denied my chest CT ordered for chest pain. They mistreat members and refused to let me speak to management. read more

After 26 years in practice, I can confidently say this group represents one of the most frustrating examples of medical administrative management I've encountered. When treating patients with serious disc issues--herniations, protrusions, and other spinal pathologies--it's not uncommon for a medically necessary treatment plan to require 20, 30, or even 40 visits. Yet, time and time again, after 10 or so years of dealing with them they arbitrarily approve just six visits. If you're lucky, you can beg for two more. But often, you spend 30 minutes on the phone, pleading your case, sending documentation, explaining the patient's condition in detail--only to be denied. Again. I even gave it one more shot after promising myself I would do this again. Just another example of how I should have listened to my instincts. A 27-year-old has permanent issues, and the quality of life is significantly reduced. A spinal injection was recommended, and they wouldn't even give the visits the orthopedist recommended, 12, let alone what my recommendations were, even AFTER performing an MRI. 8 visits. Guess I gave him 2 for free. The result? Patients are effectively stripped of the full use of their medical benefits and left without the care they need to heal properly. It's demoralizing for providers and detrimental to patients. It shouldn't be this difficult to deliver medically necessary treatment. So, switch plans...its only these guys. If i can hlp anyone else, it will be worth it. read more

I would give them a big fat zero! These people are evil. I have 3 reputed discs in my neck and no feeling in my arms just numb. No MRI for me unless I self pay. Total garbage of a company read more

I usually don't write one-star reviews, but this is a special case... I need to get an overnight sleep study at a sleep lab. The staff at the lab told me they've been working for weeks to try to get the preauthorization through eviCore, and eviCore simply keeps asking them for more info and then not responding for a long time. I was supposed to have my sleep study tomorrow, but the lab just called & said they've delayed it for 2 weeks because my preauthorization is still pending in eviCore's system. I called eviCore to try to get more info, and got nowhere. I tried the folks at Cigna, but they said I have to go through eviCore for preauthorizations. read more

I have had the same experience as many of you have stated, a denial of a preauthorization. These insurance companies are in the business of making money. I really believe these companies likely offer bonuses based on the number of claims and pre-authorizations that are denied. If these insurance companies are not held accountable for the games that they play with people's lives, the cycle will never end. The US reportedly has the one of the most expensive health care system and the worst results. This is just one of the many areas where the Affordable Care Act failed people. It simply did nothing to reign in these health care costs and the crooks that work in the health insurance industry simply continue to profit by denying claims and pre-authorizations. Insurance is in the business of collecting money, but not paying out claims. People are dying. But, it's money over lives. I wish I could give this company 0 stars. https://www.cnn.com/2024/11/07/health/evi-care-insurance-company-denials-propublica/index.html read more

I have a rare form of cancer. The overall prognosis is good, but I have stretches, sometimes for days or weeks, of pain and discomfort which regular painkillers do not help with. I have had surgery and have to have monthly injections and quarterly scans. This company, which I'd never heard of, was brought in to review my scans after the fact, and denied my coverage, meaning I'd be on the hook for tens of thousands of dollars. I had both of the qualifications necessary to justify the procedures; the hack evicore hired, who was not an expert in my type of cancer, denied it anyway. It took a nasty call from my oncologist to overturn the denial. The "doctor" in this case never met or spoke with either me or any of my doctors. He lives and practices nearly a thousand miles away. Yet he felt comfortable denying my coverage and putting me, a single person on a fixed income, on the hook for thousands of dollars. And bezos and musk wonder why Luigi Mangione is considered a hero. Anybody who uses this company, or works for it, is a vindictive ghoul and a sociopath. read more

0 stars this company denies standard of care procedures and denies care and/or delays care by forcing weeks of peer to peer conversations to take place with doctors. They take doctors away from patients and have them on hold for hours and hang up on them. Their "doctor" overrides the doctor who has seen the patient and the test and MRI results. This is difficult for the patient that has chronic health issues. Untold pain and stress is the result. This causes the doctors to drop the insurance companies that use evicore to do their delay and deny tactics for them. This company is evil. If you have the ability to choose your own health insurance company instead of you employer deciding for you, choose one that does not use evicore as a middle man for procedure approvals. read more

I am a doctor jumping through the hoops to get tests approved for my patients. After a long process of faxing required documents the test was denied and I was told that I can speak with one of my peers to review needed test IN 1 WEEK. Never mind this was STAT(urgent test). I was able to talk to this supposedly nurse by name Mary M.( would not give full name) rude and confrontational. I explained her that test was urgent otherwise I would need to sent patient to ER( which would cost insurance more money) and she decided to just hang up on me. read more

EviCore is the worst! After several calls and three different persons, I did not receive any help regarding my preauthorization to have an MRI. I was told they needed to see 6 months of treatment and a post follow up before they could authorize an approval. What happened to the the doctors know best, and not an insurance carrier. If the doctor ordered an MRI, evidently one is deemed necessary for a medical need. I also want to bring attention to the nonchalant, insincere, and sarcastic people who work for Evicore, especially the nurse. After this horrible experience I will be leaving Aetna and returning to my Ole faithful Blue Cross/Blue Shield. Never has any issues with BCBS but trying to save a few dollars, you get what you pay for. Lesson learned! read more

Wow, I just got off the phone and EviCore is stopping me from getting the medical help I need. They will do nothing to help get pre-authorization issues resolved. Woman I talked with made sure I knew she did not care and and didn't have to. I like Aetna but an very disappointed they are using a company like this. read more

Negligent company that refuses drs plan of care. They somehow know more than drs and refuse any diagnostic orders .

This company is evil. My situation is minor compared to some of the ones you'll read below. I had Aetna at the time of this incident - we switched to UHC and I am scared for this to happen again. Doctor ordered a CT scan for abdominal pain on right side. It got denied so I got an ultrasound. When the ultrasound showed nothing (as my doc predicted), he ordered another CT which was also denied. I have a history of major reconstructive intestinal surgery, and evilcore denied my claims because I am a "normal" 28 year old. Wrong! I tried to approach my care in the right way - by going to the doctor and not the ER. Next time this flares up, I will be going to the ER and insurance can enjoy the cost of the emergency CT. Edit to add: It seems earlier this year, they also removed their hundreds of Google reviews. They were also rated 1 star over on that platform. read more

I will be turning this company over to the Insurance commissioner. They denied a procedure for me, because some lady was sick on their end and didn't get the proper words corrected in time. Now my procedure will be postponed and cost me dearly due to a new year high deductible. I could only understand a very little of the broken the girl's English. What is our world coming to? read more

Same experience as others, denial of MRI on behalf of Aetna. They said I needed an x ray prior, of which I HAD TWO. Aetna gave me the fax for the results to be sent to Evicore, which my doctor did on 5/28. Evicore denied me on 6/2, and said they didn't get the x ray results. They closed my case before even investigating. They said they reached out again to my provider (lies). The nurses, doctors and imaging faculty said no- body reached out. So here I am as the patient, still in pain & have to wait another 15 business days for "appeal peer conversation." read more

Absolute idiots that work there, and worst off for the poor patients who's greedy insurances contract these people to deny procedures and services from their providers. Absolute shame that a company like this even exists! The government should really look into the legality of this so called company, as patients are suffering and providers are not getting paid. read more

While dealing in their network, they wanted me use a different facility in their network just because it is cheaper but delays my treatment by 2 weeks while I'm in pain and the pain gets worse everyday. It is upsetting to my physician, as well as, very inconvenient to me. I have to travel an extra 10 miles to their recommended facility. I'm just a number and not a person to them. Its like asking for a pick-up and given a Yugo. read more

Same issue as others have posted...I've been denied 3 times for a mri went to two doctors and a specialist who put in orders for mri to no avail...I will change my insurance company when open enrollment comes around again...you fig Aetna will do a better job read more

Cigna uses eviCore for CTScan Approvals. Cigna health giant accused of improperly rejecting thousands of patient claims using an algorithm A federal lawsuit alleges that health insurance giant Cigna used a computer algorithm to automatically reject hundreds of thousands of patient claims without examining them individually ByThe Associated Press July 25, 2023, 9:27 PM SACRAMENTO, Calif. -- A federal lawsuit alleges that health insurance giant Cigna used a computer algorithm to automatically reject hundreds of thousands of patient claims without examining them individually. The class-action lawsuit, filed Monday in federal court in Sacramento, says Cigna Corp. and Cigna Health and Life Insurance Co. rejected more than 300,000 payment claims in just two months last year. Can I rate them Less than Zero? Horrible Horrible Horrible. Their job is to DENY any and ALL procedures from Medical Doctor Specialists. Unsure why they are even in business. Disneyworld uses them via Cigna CastCare for Authorization for procedures by medical Specialists for CT Scans. Denied! If you have a serious pain that needs to be identified, you use a CT Scan! Nope, Denied! Evicore just doesn't get it. Shut them down and do the world a favor and rid ourselves from these folks. Switching health plans to get away from this mess they created. read more

Like many of you, Evicore denied an MRI. I've had extreme lower lumbar pain going on 6 weeks. I spend my days and nights with ice packs and the heating pad. They want me to go through 6 weeks of chiropracti, PT, and medicinal therapy.I try to keep an open mind, but I'm convinced by others and my own experience that these are little more than profit driven denials. My waning faith in profit driven healthcare delays and denials grows with each passing day. I was shocked and horrified by the actions of Luigi Mangione, and while I still condemn senseless acts of violence I'm beginning to have some small understanding of what may have motivated him. read more

OMGGGG. A third party group contracted by my insurance Aetna- they make recommendations for cost cutting. My experience- I was asked to have a CT scan which was approved but the in Network hospital was not approved. They let me know the week of my appointment. Now back to Aetna to find a freestanding CT facility that can get me in. It is complete cluster and adds so many unnecessary steps and time to rearrange new appointments. read more

an adjunct company that reviews claims and pre-authorization for medical procedures reviewed my claim for 27130 total hip replacement (replacement of thigh bone and hip joint prosthesis or artificial hip joint) I received a paper letter denying my surgery one week before the procedure I. had to call eviCore to appeal after receiving more information from my surgeon it had been applied A word of advice.... Contact the customer if action / surgery has been approved Very unhappy with snail mail approach read more

Rude people just hang up on you when they choose to. This is a third party company that's there to deny all your claims so they can squeeze as much ins money as they can. I was hung up on twice and was NOT rude at all. Customer service is in the toilet with this company. Good luck if your Caucasian as I was served up a huge plate of rudeness and inept help read more

Let me just start by saying that if you receive mail from this company, I am truly sorry. This company is one of the smaller companies that United Healthcare (and other large health insurance companies) use to do their dirty work to try and deflect from their 'brand'. They are the most incompetent, greedy and unhelpful people I have ever had the displeasure of interacting with. After notifying me of their denial to pay for my wife's MRI the day before it was scheduled I spent hours on the phone with them and got nowhere. Although it's mostly out of our control... Avoid them and United Healthcare at all costs. read more

The absolute worst organization ever. They absolutely give ZERO concerns about the best interest of the patient. I can completely understand how someone could "snap" dealing with insurance companies. Trying to get an auth for any procedure or surgery has been an ABSOLUTE NIGHTMARE! yet we pay 10K a year for insurance!!! read more

Horrible! Shame on Aetna for using them. My insurance is Aetna PPO yet these ignorant people decide what procedure is necessary. Despite stage IV cancer they denied a PET scan and would only approve a CT scan. My doctor appealed twice, explaining he needs to compare previous PET scan to new PET scan not to a CT scan. I go to one of the best cancer hospitals in the world and have one of the best doctors yet someone sitting in a cubicle in who knows where decides they know more than my doctor about what type of scan I need. It's criminal and they should be held accountable for their greed and ignorance. read more

I've seen 5 ENT/Plastic Surgeon's and all indicate surgery is medically necessary, yet evicore, refuses to approve stating it is cosmetic in nature and I haven't completed the six week protocol which was prescribed and followed. They do not review documentation thoroughly, and seems like their role is to deny Doctor's professional recommendations in order to save Regence from providing insurance coverage. When did the insurer become the Doctor and make medical decisions solely on their bottom line, not the patient's best interest? read more

My husband was scheduled to have knee surgery because he has a torn meniscus that requires surgery to repair. Nowhere on the BC/BS card does it say to have pre-authorization done through a separate company. Our doctor's sent the request to BC/BS on the 14th as soon as it was scheduled for a surgery on the 21st. They were not informed that it needed to go to Evicore until the 19th. Both the doctor's office and my husband called multiple times to get it expedited, but they refused because a torn meniscus is not life threatening. This has wasted the last of my PTO, and will cause my husband's Short-term disability pay to be delayed from work causing us both to lose pay for having to reschedule. read more

EviCore is the absolute worst company I have ever had to deal with. I am currently in active treatment for aggressive breast cancer. I have 5 high risk factors for recurrence of this cancer including a mutation that increases my chances and extremely dense breast. I still have my breast tissue until I can get surgery and they denied my MRI which is the standard of care. They are contracted by my insurance company, Aetna, to process authorizations and it is as if they were working against the patients. I filed a formal complaint with the state against EviCore and I would encourage you all to do the same. If we band together we can force change. read more

eviCore is horrible! All they care about is saving the insurance company money. They deny any procedure that will cost Aetna money. I had an order for a CT scan to see if I had an abdominal tumor - they said I need biopsy results before they would allow for the CT scan. (Biopsy of what!! - idiots) Also denied a CT scan of my aorta - said I needed an ultra sound of my peripheral arteries first -- Since when is the aorta a peripheral artery? Aetna should be ashamed to use eviCore and any work place that offers Aetna as good insurance must not care about their employee's and should reconsider contracting with another insurance company. read more

Evicore ,3rd party authorization for Aetna has denied my claim for spinal injections (that I desperately need) I've been getting these injections for the past 7 years. Stating I need physical therapy if which I did last year. This company is the worst, they don't know me or my history. I have chronic lower back pain. Retaining an attorney. Zero stars read more

All they do is deny needed coverage. We pay exorbitant amount for Healthcare only to be denied when we need services.

I will jump on the bandwagon of receiving less than stellar news regarding care. I'm wondering how a third party can ignore medical treatment designated by the doctor and assume they know what's best for a patient they never met. Not only are they denying service but they are potentially causing long term damage by not approving what they think is "medically necessary". This treatment they are denying is to prevent surgery, but by denying services, do I send them the bill if this leads to surgery? Shaking my head at those who play God at the expense of one's health. read more