My Health
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UM is a part of the prior authorization
process (as described in your Member
Handbook) that helps decide if certain
outpatient care, an inpatient hospital
stay or a procedure is a covered service.
Tis means that both Anthem and
your PMP (or specialist) agree that
the service is medically necessary.
Coverage decisions are based on:
•
Medical policies.
•
Nationally recognized
clinical guidelines.
•
Your health benefts.
You should know that:
•
We make decisions based on care
and services you need and the
benefts you have.
•
We do not reward doctors,
providers or decision-makers who
work with us for not approving
requested care or services.
•
We do not provide fnancial
incentives for those who make UM
decisions to encourage decisions
that result in less care given.
To learn more about the UM
process, call us toll-free weekdays
except holidays from 8 a.m. to
5 p.m. at
1-866-408-7187
. We
have a free interpretation service
at this number as well. When you
call, just ask for an interpreter in
your language.
If you call before or after hours,
you can leave a private message and
a member of our staf will return
your call on the next business day
during the hours above, unless
you request a diferent time. Any
staf member who calls you about
a UM issue will give you his or
her name and title and the name
of the company.
If you have hearing or speech loss
and want to reach UM, you can call
the TTY line at
1-866-408-7188
.
What Utilization Management (UM)
is and how it affects you
Share for better care
When you see a specialist or go to the emergency room, are you telling your PMP?
Making sure your PMP and specialists all know about all the care you get helps the
doctors so you don’t have to go through the same tests twice. And that saves time and
money. It helps to make sure you have the best outcome for your health concern. You
play a big role in making sure you get the right care for any problems you have.
Be sure to:
•
•
Share the names of each of your other doctors and other types of health care
providers with all of the doctors who give you care.
•
•
Tell your doctors, especially your PMP, when you are prescribed medicine from more
than one doctor, are hospitalized or see a specialist.
•
•
Sign a consent form for the release of medical records so your information can be
shared by different doctors and providers.
Remember to share for better care.