May 13, 2026
Coverage? Denied. Comments? Exploding.
"Not Medically Necessary": Helping America's Health Insurers Deny Coverage
Insurers’ secret denial machine sparks rage, jokes, and a big freedom-vs-fairness fight
TLDR: ProPublica reports that EviCore helps major insurers deny or delay medical care and even sells that cost-cutting as a feature. Readers were furious, with doctors calling the review process a sham and commenters battling over whether greedy companies or government should have that much power over treatment.
If this ProPublica investigation was meant to make people feel calm about health insurance, the comments did the exact opposite. The big bombshell is that EviCore, a company working with major insurers and touching coverage for more than 100 million Americans, allegedly uses an adjustable system insiders call “the dial” to increase the chances that care gets denied. The company says it’s protecting patients and cutting waste. The internet heard that and basically replied: sure, Jan.
The strongest reactions were pure fury at the idea that a business can profit by saying no to care. One physician in the thread absolutely unloaded on the so-called “peer to peer” review process, saying the people on the other end often don’t feel like real peers at all. That turned the comments from abstract policy debate into something much messier and more personal: doctors, patients, and regular readers all sounding exhausted by a system that seems designed to stall treatment while calling it efficiency.
Then came the political cage match. One camp argued this is proof private insurers should never get to decide who gets treated. Another fired back with a states-rights libertarian take, saying federal solutions would be even worse. And yes, there was dark humor too: one commenter cracked that plenty of businesses are “not medically necessary,” which is exactly the kind of joke people make when they’re one bad bill away from screaming into a pillow. In other words: the article is about algorithms, but the comments are about trust — and nobody has any left.
Key Points
- •The investigation says EviCore, owned by Cigna, handles prior-authorization reviews affecting about 100 million insured people in the United States.
- •According to the article, EviCore uses an AI-backed proprietary algorithm called 'the dial' as an initial screening tool for authorization requests.
- •The article states that the algorithm can automatically approve requests but cannot deny them; flagged cases are reviewed by in-house nurses and doctors, and only doctors can issue final denials.
- •ProPublica and Capitol Forum report that EviCore markets a 3-to-1 return on investment to insurers and that some contracts tie its compensation to reductions in health spending.
- •Using Arkansas disclosure data, the article says EviCore denied prior-authorization requests in full or in part nearly 20% of the time since 2021, compared with about 7% for federal Medicare Advantage plans in 2022.