Prior authorizations, one of health insurers’ many “utilization management” techniques, is a hot topic amongst practicing physicians, patients, and regulators, to name a few. The prior-authorization process requires a health insurer to consent to a doctor’s proposed course of treatment for a patient before the insurer agrees to pay for any medical services the physician wishes to provide. The insurer’s consent is allegedly based on whether the prescribed treatment plan is considered “medically necessary” by the insurer.
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Recent Posts
- Provider Charged with Receiving and Paying Millions in Kickbacks in Connection with Sober Homes
- UnitedHealthcare’s Changing Approach to Prior Authorizations
- HHS Proposes $9 Billion Lump Sum Payment for Hospitals to Remedy Unlawful 340B Payment Reductions
- Will The Standard of Liability Under The 60-Day Repayment Rule Change?
- New Protections for Employees of Certain New Jersey Health Care Entities
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