US Medical Term · insurance
Utilization Review
Revisión de utilización
In 9 languages
| Language | Term |
|---|---|
| English | Utilization Review |
| Spanish (Español) | Revisión de utilización |
| Chinese (中文) | 使用審查 |
| Korean (한국어) | 의료 이용 심사 |
| Vietnamese (Tiếng Việt) | Đánh giá sử dụng dịch vụ |
| Filipino (Tagalog) | Utilization review |
| Portuguese (Português) | Revisão de utilização |
| Thai (ภาษาไทย) | การตรวจสอบการใช้บริการ |
| Japanese (日本語) | 医療利用審査 |
What it means
Utilization review (UR) is the process insurers use to evaluate whether the medical care you receive — or plan to receive — is medically necessary, appropriate, and efficient. It includes three phases: prospective review (before care, which is prior authorization), concurrent review (during an inpatient stay to check ongoing necessity), and retrospective review (after care to verify appropriateness). UR is performed by nurses or physicians using established clinical criteria. If your care does not meet the criteria, the insurer may deny or reduce coverage. Federal law gives you the right to appeal utilization review decisions, and many states require independent external review.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
My insurer's utilization review team denied my inpatient stay — how do I appeal?
El equipo de revisión de utilización de mi aseguradora rechazó mi hospitalización — ¿cómo apelo?
Is a concurrent utilization review happening during my hospital stay?
¿Se está realizando una revisión de utilización concurrente durante mi hospitalización?
What clinical guidelines does your plan use for utilization review decisions?
¿Qué guías clínicas usa su plan para las decisiones de revisión de utilización?
Where you'll see it
Related terms
Sources
Last reviewed: September 2026