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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 ...
Without prior authorization, hearing aids may not be covered. Be sure to check with your insurance plan and provider to obtain prior authorization. Aetna's Discount Program with Amplifon.
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. [5]
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.
During his tenure, Aetna was named Fortune magazine's most admired Company in the Health Care: Insurance and Managed Care category for three consecutive years. [12] In 2011, Aetna's revenues were $34 billion, and the firm ranked 77th on the Fortune 100 list. Mr. Williams joined Aetna in 2001 and in 2002 was named president and joined Aetna's board.
The roughly $1,000-per-month GLP-1 drugs have caused some employers and insurers to stop covering them, or to require prior authorization in order to fill the prescription.
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.
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