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My Health
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Share for better care
When you see a specialist or go to the
emergency room, are you telling your main
or primary doctor? Make sure your doctor
and specialists all know about all the care
you get. It helps the doctors, so you don’t
have to go through the same tests twice.
That saves time and money. It also 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.
How do we decide
if we’ll cover a
treatment, procedure
or hospital stay?
We use our Utilization
Management process
Utilization Management (UM) is a process
that helps decide if certain outpatient
care services, inpatient hospital stays
or procedures are medically needed and
covered by the plan.
Decisions are only based on what is right
for each member, based on the type of
care and service. We look at standards
of care taken from:
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Medical policies.
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National clinical guidelines.
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Your health benefits.
You should know:
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Employees, consultants or other
providers are not rewarded or offered
money or other incentives to deny
care or service.
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They are not rewarded for supporting
decisions that result in the use of
fewer services.
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We do not make decisions about
hiring, promoting or firing these
people based on the idea that they
will deny benefits.
To learn more about UM or a case, call us
toll-free from 8 a.m. to 5 p.m. weekdays,
except holidays, at
1-866-408-6131
. If
you would like to talk to someone in a
language other than English, ask for an
interpreter in your language. If you have
hearing or speech loss, call the TTY line
at
1-866-408-7188
.
If you call at any other time, you can
leave a private message. Our staff will
return your call on the next business
day during the hours above. Or you can
ask that someone call you back at a
different time. Any staff members who
call you about a UM issue will give you
their name and title and the name of
the company.
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We may collect, use and share nonpublic personal information (PI) as
described in this notice. Your PI tells us who you are and is often gathered
in an insurance matter.
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We may use your PI to make judgments about your health, habits
and hobbies.
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We may collect PI about you from other persons or groups such as
doctors, hospitals or other carriers.
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We may share PI with persons or groups outside of our company without
your OK in some cases.
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We will contact you if we take part in an action that would require us to
give you a chance to opt out.
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We will tell you how you can let us know that you do not want us to use
or share your PI for a given action.
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You have the right to access and correct your PI.
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We take safety measures to protect the PI we have about you.
You can ask for a state notice that is more detailed. Please call the phone
number printed on your ID card.
Your personal information
Be sure to:
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Share the names of each of your
providers with all doctors who give
you care.
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Tell all your doctors when you are
prescribed medicine from a provider.
Tell them if you are hospitalized or see
a specialist.
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Sign a consent form to release medical
records so your information can be
shared by different providers.
It’s key to share for better care.