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.
Choose the best doctor in San Diego for you.
View Sharp Rees-Stealy doctors in San Diego.
"The Sharp Experience combines compassion for patients with delivery of the highest quality medical care."
"It is every bit as important to listen to our patients as it is to perform comprehensive evaluations."
"It is an honor to work for a well-organized institution that provides physicians with the tools necessary for excellent patient care."
"I aim to provide cutting-edge medical care in a humanistic and honest manner every day."