Utilization Management Disclosures

Utilization Management Policy Statements

Utilization Management criteria used at Health Services are available to Health Services practitioners, providers, patients/members and their representatives, and the public upon request. To obtain a copy of the criteria used to make utilization management decisions, practitioners, providers, patients/members and their representatives, and the public may contact Health Services Utilization Management at (800) 832-6334.

Affirmative Statement Regarding Incentives for Utilization Management Decisions

Health Services is committed to ensuring that our patients/members receive the best and the most appropriate care possible. Utilization management decision making is based only on appropriateness of care and evidence of coverage. Health Services does not directly or indirectly reward practitioners or other individuals for issuing denials of coverage, service or care. There are no financial incentives or compensation offered to such individuals, as utilization management decision-makers, to encourage underutilization of services.