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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 ...
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
Elevance Health, Inc. is an American for-profit health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc . [ 2 ] The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue ...
Aetna, Humana, Anthem and Cigna cited the Affordable Care Act, popularly known as Obamacare, which was passed by Congress in 2010 to significantly expand access to affordable health insurance.
Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
As of 2017, the largest commercial plans were Aetna, Anthem, Cigna, Health Care Service Corp, UnitedHealthcare, and Centene Corporation. [27] As of 2017, there were 907 health insurance companies in the United States, [28] although the top 10 account for about 53% of revenue and the top 100 account for 95% of revenue. [29]: 70
Gail Koziara Boudreaux (née Koziara, born 1960) is an American businesswoman.She is the president and CEO of Elevance Health since 2017, and has been an executive for other health insurance companies including Aetna, BlueCross BlueShield of Illinois (2002), and UnitedHealth Group (2008).
Aetna cancelled planned expansion of its offerings and following an expected $300 million loss in 2016 and then withdrew from 11 of its 15 states. [54] In August 2016 Anthem said that its offerings were losing money, but also that it would expand its participation if a pending merger with Cigna was approved. [55]
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