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  2. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...

  3. WellSpan, United Healthcare in contract dispute; Could ... - AOL

    www.aol.com/wellspan-united-healthcare-contract...

    York-based WellSpan, the third largest healthcare system in the Midstate, and Minneapolis-based United Healthcare’s contract is set to end on Oct. 31, and they have yet to agree on a new one.

  4. Preferred provider organization - Wikipedia

    en.wikipedia.org/wiki/Preferred_provider...

    In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...

  5. Letter of understanding - Wikipedia

    en.wikipedia.org/wiki/Letter_of_understanding

    A Letter of Understanding (LOU) is a formal text that sums up the terms of an undertakings of a contract which may have been negotiated up to this point only in spoken form or otherwise informally. It reviews the terms of an agreement for a service, a project or a deal and is often written as a step before a more detailed contract is issued. [1]

  6. Explanation of benefits - Wikipedia

    en.wikipedia.org/wiki/Explanation_of_benefits

    An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:

  7. Another major insurer hits contract wall with WakeMed. What ...

    www.aol.com/another-major-insurer-hits-contract...

    The contract will lapse on Jan. 1 if no agreement is reached.

  8. Health maintenance organization - Wikipedia

    en.wikipedia.org/wiki/Health_maintenance...

    The earliest form of HMOs can be seen in a number of "prepaid health plans". In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month. This is considered by some to be the first example of an HMO.

  9. Health insurance - Wikipedia

    en.wikipedia.org/wiki/Health_insurance

    A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization). The contract can be renewable (annually, monthly) or lifelong in the case of private insurance.

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