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Utilization Review
The medical records of every patient admitted to the hospital are reviewed routinely by utilization doctors and nurses in efforts to determine whether admission and continued hospitalization are necessary. This is done with frequent communication with your insurance company. Your insurance company will utilize this process to determine its continued payment for your hospital stay.
Many insurances require that the patient obtain pre-authorization before a scheduled admission or surgical procedure. You should review your policy to determine if this is necessary before entering the hospital.
Medicare beneficiaries are subject to the same type of reviews to determine medical necessity for continued hospital stay. If your records show that hospitalization is no longer indicated, and your physician agrees, you will be personally presented with a letter from the hospital indicating that you may be responsible for any additional changes as a result of continued hospitalization.
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