Evicore is a highly suspicious company, and the story of the patient who passed away in this article is sad. But I have noticed insurers do this (false claim denials) all on their own too. I and many friends have experienced Aetna routinely denying things that are explicitly covered by their plans and mentioned in the plan documents. They force you into an exhaustive cat and mouse game of chasing their team to reprocess denied claims. But after the initial denial, every conversation goes to some other part of their support team with hour long waiting times (meaning you may have to try multiple times across multiple weeks due to other obligations in your schedule), incompetent staff that barely speak English (making it hard to get the info or action you want), and very loose commitments from Aetna (they’ll promise getting back in 45 business days but even with that they won’t have done anything when you check in weeks later). I think these are purposeful games meant to deter people from successfully filing claims, by exhausting them, or simply shifting their payments into the future. I feel it is criminal. Not just in terms of fraudulent denial but in affecting people’s health by creating stress for them over big medical bills that should be covered.