Question

What is the URO's purpose?

Medical insurance

Answer 1

The term URO means Utilization Review Organization and its main purpose is to review insurance claims. The term utilization review is often flanked with the term utilization management. It is a process by which the health plan provider decides the cost effective and medically appropriate services. Utilization review and second opinion are very important for high cost procedures in order to decide while taking up insurance. The utilization reviews can be divided into 3 categories

Prospective review: It means that the permission or approval being taken before the actual procedure is performed. This means during this review it is determined that whether the stated procedure is required or not. This is done so that individuals don’t fraud the companies.

Concurrent review: It means the approval being taken during the procedure is being performed. Example of this category is when the patient requires extended stay in the hospital beyond the prior approved length of stay.

Retrospective review: Approval is being taken after the procedure has been performed.