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UnitedHealthcare (UHC) is an insurance and managed care company with four main divisions: UnitedHealthcare Employer and Individual – provides health benefit plans and services for large national employers and individuals. UnitedHealthcare Medicare and Retirement – provides health and well-being services to individuals age 65 and older. [80]
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 ...
A 2023 Commonwealth Fund survey meanwhile found that 17% of people said their insurer had denied medical treatment that a doctor had recommended. Sixty percent of those individuals said this ...
Case managers working for health care providers typically do the following: Verify coverage & benefits with the health insurers to ensure the provider is appropriately paid; Coordinate the services associated with discharge or return home; Provide patient education; Provide post-care follow-up; and; Coordinate services with other health care ...
Wolf rejected Optum's request and allowed Smith's, putting court proceedings on hold until the arbitration process is complete. [ 31 ] The case garnered media attention as setting a precedent in trade secret litigation ahead of an anticipated wave of vertical integration in the healthcare industry [ 32 ] and for uncovering previously unknown ...
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