[ahepp]

I understand that nobody likes to talk about setting this threshold, but it's not some kind of unique feature of the American healthcare system. I think the article raised some reasonable concerns about EviCore, but it would be a lot stronger if it did more to contextualize denials in terms of the other quadrants (correct approval, correct denial, incorrect approval, incorrect denial). It would also be interesting to compare those statistics across types of insurers (for-profit, not-for-profit, and government).

[ceejayoz]

The threshold is not unique.

Having several layers of private, for-profit companies incentivized to deny deciding that threshold is fairly unique.