The Denial Algorithm: How Insurers Systematically Reject Medical Care

EviCore, owned by Cigna, uses an AI-powered algorithm to automate denial decisions for medical treatments affecting over 100 million Americans. The company's contracts create financial incentives to maximize rejections—earning 3-to-1 returns on investments—meaning the more claims denied, the more revenue generated. This system prioritizes insurer profits over patient care, with documented cases where necessary procedures like cancer treatment and cardiac scans are denied despite physician recommendations.