In the fall of 2016, the then Representative (now Senator) Shelly Short met with our staff at Deer Park Physical Therapy & Fitness Center to discuss the new third party review process where Premera, Asuris and Regence have contracted with a company called “eviCore” to pre-authorize medical visits to Specialist providers.

Physical therapy falls within the “Specialty” category.  eviCore states, “Through our exceptional capabilities-and an acute sensitivity to the needs of everyone involved-we harness healthcare’s evolving demand and inherent change to better manage and optimize health benefits.”

(From left to right) Deer Park Physical Therapy & Fitness Center owner Bev Roberts, State Senator Shelly Short and Billing Specialist Heather Hammons

(From left to right) Deer Park Physical Therapy & Fitness Center Administrative Assistant Bev Roberts, State Senator Shelly Short and Billing Specialist Heather Hammons

Since the eviCore process was put in motion in November 2016, the time required to confirm benefits and request and receive authorization to treat patients has increased.  The ability of subscribers to access the benefits they have paid for has decreased.

Some subscribers have been denied treatment even though according to their paid policy they still had benefits available.  The authorization process by eviCore essentially overrides the written prescription by the patient’s physician in this process for Specialty care.

As a result, on March 29 Senator Short will convene a Work Group with the above insurance companies and the Insurance Commissioner’s office in Olympia. Deer Park Physical Therapy & Fitness Center has been invited to present its findings to this group.

Here is where you come in. If you, or someone you know, has had delayed treatment or has been denied treatment for physical therapy or treatment with an MD Specialist due to the new process with these three companies, this is your opportunity to be part of making a difference. You are invited to write us a letter describing your experience.  We will take the information we receive to the Work Group meeting in Olympia. Our goal is to provide useful information from subscribers in our community that will lead to changes to this expensive process for patients and healthcare providers in Washington State.  You can send your letter to Deer Park Physical Therapy & Fitness Center, 707 South Park Street, Deer Park WA, 99006 or email Bev Roberts at [email protected].

You can also provide your input by contacting the Washington State Insurance Commissioner at www.insurance.wa.gov or by phone at 800-562-6900.

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