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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 ...
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.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates.
Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and ...
For premium support please call: 800-290-4726 more ways to reach us
For premium support please call: 800-290-4726 more ways to reach us
After the passage of the ACA, 32 states used the funding of the ACA to expand their state's low-income insurance programs, such as Medi-Cal, and 19 states opted out. The 19 states, as of 2014, had a 15% higher poverty rate than the 32 states that chose to expand their services. California was one of the states to expand its Medicaid program. [6]
In 2007, 87% of Californians had some form of health insurance. [47] Services in California range from private offerings: HMOs, PPOs to public programs: Medi-Cal, Medicare, and Healthy Families . Insurers can pay providers a capitation only in the case of HMOs. [48]