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  2. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    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 ...

  3. Prior authorization - Wikipedia

    en.wikipedia.org/wiki/Prior_authorization

    After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.

  4. Blue Cross Blue Shield Association - Wikipedia

    en.wikipedia.org/wiki/Blue_Cross_Blue_Shield...

    In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [ 11 ] Prior to 1986, organizations administering BCBS were tax exempt under 501(c) (4) as social welfare plans.

  5. 'Would he have lived?' When insurance companies deny ... - AOL

    www.aol.com/lived-insurance-companies-deny...

    The largest private U.S. health insurers are Aetna, Blue Cross Blue Shield entities, Cigna Healthcare, Elevance Health (formerly Anthem), Humana Inc. and United Healthcare.

  6. Who will Steelers play in NFL playoffs? Scenarios, potential ...

    www.aol.com/steelers-play-nfl-playoffs-scenarios...

    The Steelers are headed to the playoffs, but who will they play? Here's a look at Pittsburgh's potential playoff opponents.

  7. Medicare Advantage - Wikipedia

    en.wikipedia.org/wiki/Medicare_Advantage

    In 2019, MA operators denied 13% of prior authorization requests that would have been accepted under traditional Medicare. [17] In 2019 alone, MA plans cost tax-payers $9 billion more than if those enrollees were in traditional Medicare. [18]

  8. T-Mobile class action lawsuit alleges company disguised fee ...

    www.aol.com/t-mobile-class-action-lawsuit...

    A recently announced class action lawsuit filed against T-Mobile alleges the company has disguised a hidden fee as a government charge for two decades.. The wireless network allegedly ...

  9. Health insurance in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_insurance_in_the...

    Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state, and also act as administrators of Medicare in many states or regions of the United States, and provide coverage to state government employees as well as to federal government employees under a nationwide option of the Federal Employees Health ...