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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. [1] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...
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 appropriateness before it is provided using evidence-based criteria or guidelines.
Medical underwriting is a health insurance term referring to the use of medical or health information in the evaluation of an applicant for coverage, typically for life or health insurance. As part of the underwriting process, an individual's health information may be used in making two decisions: whether to offer or deny coverage and what ...
McCarran–Ferguson Act. The McCarran–Ferguson Act, 15 U.S.C. §§ 1011-1015, is a United States federal law that exempts the business of insurance from most federal regulation, including federal antitrust laws to a limited extent. The 79th Congress passed the McCarran–Ferguson Act in 1945 after the Supreme Court ruled in United States v.
You pay insurance premiums to make sure you’re protected when things go wrong. However, if you do need to file a claim, your insurance company can, and may, deny it. There are some steps you can ...
If you decide to cancel your term life insurance, the process is usually pretty simple. One of the most effective ways to cancel is by stopping your premium payments. Simply stop sending in the ...
Life insurance can help cover end-of-life expenses, estate planning, legacy funds and long-term care. Life insurance does not pay out for certain deaths, such as suicide, within the first two ...
The National Organization of Life and Health Insurance Guaranty Associations[1] (often abbreviated NOLHGA) is a voluntary, U.S. association made up of the life and health insurance guaranty associations of all 50 states and the District of Columbia. NOLHGA was founded in 1983 to coordinate the efforts of state guaranty associations to provide ...