Utilization Review
What Does Utilization Review Mean?
A utilization review is an assessment of healthcare services, treatments, and facilities conducted by a doctor or nurse. The goal of these reviews is to ensure that health insurance companies do not spend money on services or treatments that are unnecessary or inefficient for proper patient care.
Insuranceopedia Explains Utilization Review
Utilization reviews serve as a way for health insurance companies to monitor healthcare services. If a significant finding emerges during a review, it can influence how the insurer writes future policies. For example, if a utilization review reveals that a particular doctor is charging 30% more for comparable procedures, the insurance company may decide to no longer cover that doctor. To be legitimate, utilization reviews must be conducted by qualified individuals.
