Sharp Rees-Stealy Medical Group
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 858-499-2600 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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"I strive to provide friendly, compassionate care to my patients in a way I would want to be treated."
"I evaluate and treat patients, keeping in mind that mutual trust is critical to successful treatment."
"The thought of helping kids when they cannot express themselves is very compelling."
"The Sharp Experience means taking care of everyone — from patients to medical staff — to achieve optimal care and happiness for quality outcomes."
"My goal is to empower patients to improve their health so they can take advantage of all the things life has to offer."
"The Sharp Experience means treating people, not patients, and transforming the health care experience for our entire community."
"Patient well-being is my top priority and I treat each person as I would want my own family treated."
"I provide quality, personalized care focused on the best outcomes for each of my patients."