Maryland Life and Health Insurance License Practice Exam

What is the purpose of concurrent review in health insurance?

1. To assess the cost of treatments

2. To ensure timely payment for services

3. To oversee the insured's hospital stay as planned

4. To evaluate long-term care needs

The correct answer is: To oversee the insured's hospital stay as planned

The purpose of concurrent review in health insurance is primarily to oversee the insured's hospital stay as planned. This process involves the ongoing evaluation of the necessity and appropriateness of a patient’s hospital stay while they are still admitted. It aims to ensure that the treatment is in alignment with the patient's health care plan and that the duration of the stay is justified based on the patient's ongoing medical needs. By utilizing concurrent review, insurers can facilitate effective management of health care resources, ensuring that patients receive the right level of care without unnecessary extensions to their hospitalization. This function is pivotal in managing inpatient care and helps to optimize treatment effectiveness while also containing costs related to extended hospital stays. Overall, concurrent review helps to support patients' health outcomes while simultaneously managing the financial aspects of care.