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2. Prior authorization - Wikipedia

   en.wikipedia.org/wiki/Prior_authorization

   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. [2] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...

3. Step therapy - Wikipedia

   en.wikipedia.org/wiki/Step_therapy

   It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary.

4. 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.

5. The pros and cons of Medicare Advantage plans - AOL

   www.aol.com/finance/pros-cons-medicare-advantage...

   When describing prior authorization rules of Medicare Advantage plans, U.S. Health and Human Services Inspector General reports found “widespread and persistent problems related to denials of ...

6. Oklahoma bill would make medical care requiring prior ... - AOL

   www.aol.com/oklahoma-bill-medical-care-requiring...

   The bill defines prior authorization as “the process by which utilization review entities determine the medical necessity and medical appropriateness of otherwise covered health care services ...

7. James Zadroga 9/11 Health and Compensation Act - Wikipedia

   en.wikipedia.org/wiki/James_Zadroga_9/11_Health...

   The World Trade Center Health Program provides treatment services and medical benefits for people who worked in response and recovery operations as well as for survivors of the 9/11 terrorist attacks. [17] On October 1, 2015, the Zadroga Act expired. Jon Stewart went to Congress with first responders and campaigned for the act's re ...