What is the process called that controls how policyholders utilize their policies?

The process that regulates how policyholders utilize their policies is known as medical cost management. This involves strategic practices and policies that insurance companies implement to influence the healthcare services that members use, thereby controlling costs associated with medical care. Medical cost management typically includes techniques such as prior authorization, case management, and provider networks that help ensure that necessary treatments are approved while managing unnecessary expenditures.

This process is crucial in ensuring that not only does the insurance company maintain financial stability, but it also ensures that policyholders receive appropriate care. It helps align the services provided with the benefits outlined in the health insurance policy, addressing potential issues like overutilization of services or unapproved treatments.

Other concepts listed, such as medical assessment, policy formulation, and health benefit coordination, focus on different aspects of insurance or healthcare management and do not specifically refer to the control mechanisms regarding policy utilization. Thus, they do not encapsulate the comprehensive management of how policyholders use their insurance benefits in the way that medical cost management does.