Managed-Care / Utilization Review - Kentucky

Managed-Care / Utilization Review - Kentucky

Managed-Care/Utilization Review is a legal document that was released by the Kentucky Labor Cabinet - a government authority operating within Kentucky.

FAQ

Q: What is managed care?
A: Managed care is a system of healthcare delivery where insurance companies or organizations manage and coordinate healthcare services for their members.

Q: What is utilization review?
A: Utilization review is a process used by insurance companies to evaluate the appropriateness and necessity of medical treatments and services.

Q: Why is utilization review important?
A: Utilization review helps ensure that healthcare services are provided in the most effective and cost-efficient manner.

Q: Who conducts utilization review in Kentucky?
A: Utilization review in Kentucky is typically conducted by insurance companies or organizations contracted by the insurance companies.

Q: What happens during the utilization review process?
A: During utilization review, medical professionals review medical records and treatment plans to determine if they meet established criteria for coverage.

Q: Can utilization review result in denial of coverage?
A: Yes, utilization review can result in denial of coverage if the requested treatment or service is deemed not medically necessary or appropriate.

Q: Can patients appeal a denial of coverage?
A: Yes, patients have the right to appeal a denial of coverage and can follow the established appeals process with their insurance company.

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Form Details:

  • The latest edition currently provided by the Kentucky Labor Cabinet;
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  • Easy to customize;
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Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Kentucky Labor Cabinet.

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