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Utilization management
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<p>Utilization management (UM) or utilization review is the use of <a href="/facts/Managed_care/Jn4aXLPF">managed care</a> techniques such as <a href="/facts/Prior_authorization/pXg5GIkL">prior authorization</a> that allow payers, particularly <a href="/facts/Health_insurance/sGeHMbID">health insurance</a> companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines. </p><p>Critics have argued that if <a href="/facts/Cost_reduction/hqbQbchh">cost-cutting</a> by insurers is the focus of their use of UM criteria, it could lead to <a href="/facts/Health_care_rationing/ukbrlVol">healthcare rationing</a> by overzealous denial of care as well as retrospective denial of payment, delays in care, or unexpected <a href="/facts/Financial_risk/UdGAclEI">financial risks</a> to patients. </p>