Health / Health Insurance Glossary

Utilization Review (UR): The evaluation of the medical necessity, efficiency, and/or appropriateness of healthcare services and treatment plans.

Utilization Review Committee: Committee that reviews utilization issues brought to it by the medical director, often approving or reviewing policy regarding coverage, reviewing utilization patterns of providers, and appr . . . View Full Definition

Utilization Review Organization (URO): External reviewers who assess the medical appropriateness of suggested courses of treatment for patients, thereby providing the patient and the purchaser increased assurance of the appropria . . . View Full Definition

Variances: The differences obtained from subtracting actual results from expected or budgeted results.

Waiting Period: A period of time when you are not covered by insurance for a particular problem.

Withhold: A percentage of a provider's payment that is 'held back' during the plan year to offset or pay for any cost overruns for referral or hospital services. Any part of the withhold not used for . . . View Full Definition

Workers Compensation: A state-mandated insurance program that provides benefits for healthcare costs and lost wages to qualified employees and their dependents if an employee suffers a work-related injury or disease.

Workers Compensation Indemnity Benefits: Benefits that replace an employee's wages while the employee is unable to work because of a work-related injury or illness.

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