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Prior authorization, or preauthorization, [1] is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication.
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 ...
The prior authorization, or pre-certification process, requires healthcare providers to get coverage approval for certain non-emergency procedures. Cigna removes pre-authorization requirement for ...
The insurance which pays on behalf of insureds negotiate with medical providers, sometimes using government-established prices such as Medicaid billing rates as a reference point. [148] This reasoning has led for calls to reform the insurance system to create a consumer-driven healthcare system whereby consumers pay more out-of-pocket. [242]
Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. [5]: TS 2:21 Such plans are routinely part of national health insurance programs. For ...
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Moratorium underwriting is an alternative method of health insurance which primarily allows for applicants to receive cover without disclosing their entire medical history. Instead, individuals will typically have any pre-existing medical conditions excluded if those have developed within the past five years.
Here is each school to win a Heisman Trophy, and the players who brought the big award home: The Heisman Trophy before a press conference in the Astor Ballroom at the New York Marriott Marquis.