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evicore: A Company behind your Healthcare Company

Have you attempted to make an unusual purchase using your credit card, only to be denied by the card company? Perhaps you were traveling to a new place, and you did not know to notify your credit card company ahead of time of your itinerary, and they blocked your purchases on the grounds of fraud prevention, thinking someone might have stolen your identity. How would they know, amid all their 1,000s of customers and many more 1,000s of purchases, what is outside your normal purchasing tendencies? Did you know you have a purchasing profile, based on those tendencies? We all have that profile and the company behind your card company might be FICO, using their Falcon Fraud Manager service. Credit card companies use your purchasing norms and employ sophisticated algorithms to establish your own purchasing profile. Step outside of it, and, your credit card is “blocked.” They are a company behind a company you use everyday.

Did you know your health insurance carrier uses other companies behind and with your insurance company? There are more than one, but I want to speak about one I recently learned about: eviCore. Learn about this to understand how they are working with your carrier to help supply you with timely and cost-saving options for your health care.

Yesterday, I was at an annual employer benefits enrollment meeting for all employees in the Hickory, NC area. An employee I’ve known for years told me of an account that recently happened to her. She’d put off having a CT scan for some time, and she finally relented, although she understood the full amount would be applied to her deductible. Her primary care provider [PCP] booked her appointment, knowing it would cost her a minimum of $4,100 to be applied to her deductible, and she thought that was that. Shortly afterwards, she received a call from her carrier. We discovered, it was eviCore working alongside in conjunction with her insurance carrier.

The eviCore representative identified herself and told this employee there were other imaging options available for her that she might want to consider, if she did not mind leaving the Hickory area for the service. This CT scan, like just about all other things in the medical community, has a procedure code, called a CPT code.  There are thousands of these codes that standardize many if not all medical procedures. This made apples-to-apples comparisons between one imaging provider to another plausible. The rep gave this employee the contact information of the other facilities, along with some basic instructions, and off she went!

To her pleasant shock [and my shock and the collective shock of the insurance experts that were there at the meeting with me] she was quoted alternative rates ranging from $490 to $2,100 for the same procedure. These facilities were in Gastonia at Novant and in Belmont at CaroMont. For that cost difference, she did drive to Gastonia, opting for the $490 rate at Novant, about a 45 minute drive down the highway. And, a consumer-driven health care evangelist was born!

I’ve learned that eviCore is primarily used in this fashion for making outbound, intervention-type calls for high-tech radiation imaging like CT, MRI, and PET scans, and high-cost pain management, only. But insurance carriers have many other resources about many other cost-savings treatment options through on-line portals, apps, and just by calling customer or member services, and speaking with them about how you might take more control of your own healthcare. This is consumerism, which is the use of relevant and timely information freeing us to make our own purchasing decisions in a free market, is our best option for bringing down the cost of healthcare. Go and discover your companies behind your company, and become your own healthcare evangelist!

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