Navigating the letter from EviCore: If the request from your healthcare provider doesn’t meet the evidence-based guidelines, you’ll receive a letter from EviCore letting you know it wasn’t approved and why. The “why” will include a reference to the medical guidelines in question, which are completely transparent and available on EviCore’s website for your review. Sometimes these letters may include an alternative course of action that would better meet the guidelines.

These are some of the most common reasons that a test, treatment, or procedure might not be approved:

Need more clinical information: Sometimes EviCore needs more clinical information from your healthcare provider, like medical history or tests you’ve already had, to determine if the request meets the latest evidence-based medical guidelines.