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CB General Health Review of EviCore
EviCore

EviCore review: Requested visits by physical therapist approved.

M
Author of the review
5:35 pm EDT
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I have Regence MedAdvantage. They use EviCore to approve or deny preauthorizations. I was denied care after my physical therapist gave them all of the required documentation. I called Regence and they said that EviCore dealt with preauthorizations. I called Evicore and they said it was denied because it wasn't necessary, the case is closed and they will not re-open it. They expect my provider to start the process all over again, when she has already given them the documentation needed. They did not even look at the codes and documentation that was sent to them. I have an MRI that explains some of what is going on. I have a doctor that said to get physical therapy to see what can be done. I have a chiropractor that has clinical records documenting my on-going pain. Who is EviCore that they are dictating what is necessary for physical therapy? The paperwork the physical therapist sent in shows the disability. Medicare covers the work needed and EviCore will not approve the visits.

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