Making sure members get the right care
Our Utilization Management (UM) program ensures members receive the right care in the right setting when they need it. UM staff can help you and our members make decisions about their health care. Our UM program helps make sure members receive the right services at the right place. When we make decisions, it's important to remember the following:
- We make UM decisions by looking at members' benefits and choosing the most appropriate care and service. Members also must have active coverage.
- We don't reward providers or other people for denying coverage or care.
- Our employees do not get any incentives to reduce the services members receive.
Practitioners may freely communicate with patients about all treatment options, regardless of benefit coverage limitations.
You can speak to a person to ask questions about UM by calling Utilization Management toll-free at 1-866-600–2139 (TTY: 711).