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Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
As of 2017, 11 insurance companies offer plans through Covered California, however depending on the county in which an individual lives, the number of insurers can vary from two to seven. [32] A 2015 California Healthcare Foundation study found that the number of hospitals in an insurance network did not significantly affect the quality of care ...
Two state-based health insurance regulators is unusual in the United States, and has led to various additional work to synchronize laws. [3] This dual regulation arose due for historical reasons, and when the DMHC was created in 2000, the California legislature requested a report on merging the health insurer responsibilities with the CDI. [4 ...
As insurance premiums have surged, families with employer-sponsored health care plans have paid nearly 5% of their total earnings over a 32-year period, according to a 2024 report investigating ...
The Affordable Care Act (ACA) established the health insurance rate review program in order to protect consumers from unreasonable rate increases. [1] Through this program, proposed premium increases in the small group and individual markets that are above a threshold amount (ten percent or more, as of February 2014) are reviewed by states or the federal government to determine whether the ...
In 1998, L.A. Care became involved in the Healthy Families program, California's version of the Children's Health Insurance Plan (CHIP), and then in 2003 launched L.A. Care's Healthy Kids program for children ages 0–5, funded in partnership with First 5 LA and the Children's Health Initiative of Greater Los Angeles. Healthy Kids was ...
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