US Medical Term · insurance
Retrospective Review
Revisión retrospectiva
In 9 languages
| Language | Term |
|---|---|
| English | Retrospective Review |
| Spanish (Español) | Revisión retrospectiva |
| Chinese (中文) | 事後審查 |
| Korean (한국어) | 사후 검토 |
| Vietnamese (Tiếng Việt) | Đánh giá hồi cứu |
| Filipino (Tagalog) | Retrospective na pagsusuri |
| Portuguese (Português) | Revisão retrospectiva |
| Thai (ภาษาไทย) | การทบทวนย้อนหลัง |
| Japanese (日本語) | 事後審査 |
What it means
Retrospective review is a type of utilization review conducted by an insurer after a medical service has already been provided. The insurer evaluates whether the completed care was medically necessary and appropriate. This review commonly applies to emergency services, services provided when prior authorization could not be obtained in advance, or when verifying that care met the plan's clinical criteria. If the retrospective review determines care was not medically necessary, the insurer may deny payment for all or part of the claim. Providers and patients typically have the right to appeal a denial that results from a retrospective review decision.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
My claim is under retrospective review — how long will this process take?
Mi reclamo está bajo revisión retrospectiva — ¿cuánto tiempo tomará este proceso?
The retrospective review denied my emergency room claim — can I appeal this decision?
La revisión retrospectiva denegó mi reclamo de sala de emergencias — ¿puedo apelar esta decisión?
What documentation does the retrospective review team need from my provider?
¿Qué documentación necesita el equipo de revisión retrospectiva de mi proveedor?
Where you'll see it
Related terms
Sources
Last reviewed: September 2026