predetermination


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predetermination

Managed care A requirement for prior approval from a health insurer before it will pay for a proposed treatment. See Red tape rationing.

pre·de·ter·mi·na·tion

(prē'dĕ-tĕr'mi-nā'shŭn)
Determination of the reimbursement amount from a third-party payor before a health care service is performed. It does not guarantee coverage.

pre·de·ter·mi·na·tion

(prē'dĕ-tĕr'mi-nā'shŭn)
Determination of the reimbursement amount from a third-party payor before a health care service is performed. It still does not guarantee coverage.
References in periodicals archive ?
The results of this analysis have demonstrated that no such sweeping predeterminations can be made, but rather that 'it depends'.
Check your policy, including whether or not your surgeon needs to write a "predetermination letter."
It points to the inscrutability of fate, which remains fate in its predetermination, manifesting itself in the inevitability of death.
(111) The court, defining "predetermination" as occurring only when an agency "irreversibly and irretrievably commits itself to a plan of action that is dependent upon the NEPA environmental analysis producing a certain outcome," (112) makes it clear that "predetermination is different in kind from mere 'subjective impartiality[,]'" which "'does not undermine an agency's ability to engage in the requisite hard look at environmental consequences...." (113)
Molina's arguments may or may not have succeeded in liberating the human will from divine predetermination, but it is very difficult to argue that middle knowledge released human beings from the predictive powers of other humans.
From the seller's standpoint, predetermination makes competition irrelevant and supports price elasticity.
Most important, making a predetermination to carry on in spite of pending adversity can act as a fortitudinous "booster shot" and help to inoculate a leader against the temptation to quit a matter too soon.
The business process will evolve from a system of strict predetermination toward one based on trust.
(35) Proponents of the warrant requirement assert that the Fourth Amendment is "quintessentially a regulation of the police," and a judicial predetermination of the basis for probable cause is a necessary check on otherwise unfettered police discretion.
The poem became a meditation on creation versus destruction, on predetermination versus chance, on order (or the human need to create order through science and religion) versus the more natural forces of chaos.
There was a predetermination to use mistaken headlines, when the press claimed that the pictures were of the El-Oyoun camp victims.