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  2. Prior authorization - Wikipedia

    en.wikipedia.org/wiki/Prior_authorization

    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.

  3. Utilization management - Wikipedia

    en.wikipedia.org/wiki/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 medical appropriateness before it is provided, by using evidence-based criteria or guidelines.

  4. Exclusive provider organization - Wikipedia

    en.wikipedia.org/wiki/Exclusive_provider...

    In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.

  5. Cigna removes pre-authorization requirement for 25% of ... - AOL

    www.aol.com/news/cigna-removes-pre-authorization...

    The prior authorization, or pre-certification process, requires healthcare providers to get coverage approval for certain non-emergency procedures. ... Cigna Group said on Thursday it would remove ...

  6. Managed care - Wikipedia

    en.wikipedia.org/wiki/Managed_care

    Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.

  7. Step therapy - Wikipedia

    en.wikipedia.org/wiki/Step_therapy

    Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription.It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs.

  8. How to Buy Life Insurance With a Pre-Existing Condition - AOL

    www.aol.com/buy-life-insurance-pre-existing...

    For premium support please call: 800-290-4726 more ways to reach us

  9. Health insurance - Wikipedia

    en.wikipedia.org/wiki/Health_insurance

    Insurance companies determine what drugs are covered based on price, availability, and therapeutic equivalents. The list of drugs that an insurance program agrees to cover is called a formulary. [7] Additionally, some prescriptions drugs may require a prior authorization [88] before an insurance program agrees to cover its cost.