Utilization Management

Why Choose Us?

  • Sharp Rees-Stealy’s Utilization Management Department is responsible for determining what health care services are covered and payable under the health plan
  • These determinations are based on criteria that assess clinical information and individual circumstances, which include durable medical equipment, hospital admissions, home-health care services and skilled-nursing facility admissions

You may obtain a copy of the actual benefit provision, guideline, protocol or other similar criterion on which the decision was based, upon request, by calling 858-499-2406.

For More Information
To learn more about utilization management, please call your treating physician. Be sure to select a primary care doctor at Sharp Rees-Stealy when you choose your insurance plan. For help choosing a Sharp Rees-Stealy doctor who is right for you, call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm, or search Sharp Rees-Stealy doctors.