Utilization Management decision making is based only on the appropriateness of care and service and existence of coverage. Sharp Rees-Stealy does not specifically reward practitioners or other individuals for issuing denials of coverage or service care. Sharp Rees-Stealy does not offer financial incentives to utilization management decision makers that encourage decisions that result in underutilization. Practitioners are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion or any other similar matters.
- 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 refer questions to the Utilization Management department or obtain a copy of the actual benefit provision, guideline, protocol or other similar criterion on which the decision was based, upon request and free of charge, by calling 858-499-2406 or 1-800-377-4277. Language assistance is available for members to discuss utilization management issues.
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, 7 am to 7 pm, or search Sharp Rees-Stealy doctors.
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"Surgery involves the physical intervention that affects a patient's physiological, psychological and emotional well-being."
"I evaluate and treat patients, keeping in mind that mutual trust is critical to successful treatment."
"I make sure my patients are supported and informed to lead healthy, productive lives."
"I treat patients as I would want a physician to treat my own friend or family member."
"The Sharp Experience means outstanding care by a compassionate and dedicated team of professionals."
"My philosophy is to treat everyone with kindness and respect and provide high-quality care."
"I enjoy working with patients and educating them on ways we both can improve their health."
"The Sharp Experience means utilizing the doctor-patient relationship to motivate healthy lifestyle decisions — improving quality of life, health and longevity."