GLOSSARY OF HEALTH INSURANCE TERMS

U

Unassigned Claim — a claim submitted for a service or supply by a provider who does not accept assignment.

Unbundling — the practice of a provider charging separately for services that normally are covered under one procedure code.

Uninsured — people who lack public or private health insurance.

Universal Coverage — a type of government-sponsored health plan that would provide healthcare coverage to all citizens.

Urgent Services — benefits covered in an Evidence of Coverage that are required to prevent serious deterioration of an insured's health that results from an unforeseen illness or injury.

Urologist — a physician who specializes in treatment of urinary tract and kidneys.

Urgent Care Center — an ambulatory care facility that provides 24-hour service to treat minor conditions such as cuts, bruises, sprains and suture removal that is less costly than emergency room treatment.

Utilization — use of services and supplies. Utilization is commonly examined by patterns or rates of use of a single service or type of service such as hospital care, physician visits and prescription drugs.

Utilization Review (UR) — a formal review of utilization for appropriateness of health care services delivered to a member on a prospective, concurrent or retrospective basis. In a hospital, this includes review of the appropriateness of admissions, services ordered and provided, length of a stay, and discharge practices, both on a concurrent and retrospective basis. A peer review group, or a public agency can do utilization review. UR is a method of tracking, reviewing and rendering opinions regarding care provided to patients.