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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.
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.
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.
In 1820, there were 17 stock life insurance companies in the state of New York, many of which would subsequently fail. Between 1870 and 1872, 33 US life insurance companies failed, in part fueled by bad practices and incidents such as the Great Chicago Fire of 1871. 3,800 property-liability and 2,270 life insurance companies were operating in ...
[42] [43] [44] Excellus was the target of a cyberattack in 2015, in which 10.5 million records were hacked, and cost the company 17.5 million dollars. [45] The company's Blue Cross Blue Shield subsidiaries have been known as: [46] BlueCross BlueShield of Central New York; BlueCross BlueShield of the Rochester Area; BlueCross BlueShield of Utica ...
People's Insurance Company of China China: 84.5 10 Assicurazioni Generali Italy: 80.3 11 Humana United States: 79.8 12 Berkshire Hathaway United States: 71.6 13 State Farm United States: 71.1 14 Munich Re Germany: 64.7 15 CVS Health United States: 62.2 16 Life Insurance Corporation India: 56.6 17 China Pacific Insurance Company China: 53.7 18
WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. WellCare began operations in 1985 and has its headquarters in Tampa, Florida.
Examples included litigation between Aetna and a group of surgical centers over an out-of-network overbilling scheme and kickbacks for referrals, where Aetna was ultimately awarded $37 million. [25] While Aetna has led the initiative, other health insurance companies have engaged in similar efforts. [26]