Method used by insurance companies and managed care plans to establish their fee schedules in which three fees are considered in calculating payment: (1) The usual fee is the fee typically submitted by the physician, (2) the customary fee falls within the range of usual fees charged by providers of similar training in a geographical area, and (3) the reasonable fee meets the aforementioned criteria or is considered justifiable because of special circumstances.
Insurance Encyclopedia
Usurped power
This is: ‘(a) invasion by foreign enemies to give laws and usurp the government, or (b) internal armed force in rebellion assuming the power of government by making laws and punishing for not obeying those laws. Usurped power involves organised tumult or open warfare, and must be something more than action by a mere unorganised rabble; it implies a more or less organised body with more or less authoritative leaders’. (F.H. Jones).
Utah Health Information Network
Public-private coalition for reducing health care administrative costs through the standardization and electronic exchange of health care data.
Utilitarianism
Philosophical view or doctrine of ethics that the purpose of all action should be to bring about the greatest happiness for the greatest number of people and that the value of anything is determined by its utility.
Utility
The subjective value given by an individual to monetary results; large losses generally cause greater relative loss of utility than small losses for most individuals.
Utilization
Measurement of the frequency that members of a health insurance group use the services or procedures of a particular benefit plan, stated by average number of claims per insured over a specific time period.
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How much a covered group uses a particular insurance plan or program.
Utilization (Health Insurance)
The amount of use a health plan gets from a certain group of policyholders.
Utilization and Quality Control Peer Review Organization (PRO)
Program that replaced the Professional Standards Review Organization (PSRO) program. See Quality Improvement Organization (QIO) program .
Utilization and review committee (Health Insurance)
A committee that monitors Medicare. The health care professionals that make up this committee observe the medical services and supplies given to Medicare patients.
Utilization management (Health Insurance)
A method of assessing the need for certain medical services.