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2. Prior authorization - Wikipedia

   en.wikipedia.org/wiki/Prior_authorization

   Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [2] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...

3. Medical necessity - Wikipedia

   en.wikipedia.org/wiki/Medical_necessity

   Medicare pays for medical items and services that are "reasonable and necessary" or "appropriate" for a variety of purposes. [1] By statute, Medicare may pay only for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member" unless there is another statutory authorization for payment.

4. Utilization management - Wikipedia

   en.wikipedia.org/wiki/Utilization_management

   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.

5. How UnitedHealthcare and other mega-insurers came to ... - AOL

   www.aol.com/finance/unitedhealthcare-other-mega...

   A survey by the American Medical Association found 24% of physicians reported that the prior authorization process led to an “adverse event” for a patient in their care.

6. The pros and cons of Medicare Advantage: Should you ... - AOL

   www.aol.com/finance/medicare-advantage-pros-cons...

   Prior authorization is not needed for most services and supplies, including medications and dental, hearing and eye services ... mental health treatment and substance abuse disorder treatment ...

7. What are the different parts of Medicare? - AOL

   www.aol.com/lifestyle/different-parts-medicare...

   The Centers for Medicare and Medicaid Services (CMS) administers Medicare. In 2022, 65.1 million Americans had Medicare, and 3.9 million of those were new beneficiaries.. Medicare has four parts ...