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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"It is important to consider the impact that diseases have on a person's total sense of well-being."
"I treat each patient as a whole person and deliver comprehensive care to family members of all ages. "
"I try to get patients back to both work and normal activity levels as quickly as possible."
"I provide quality, personalized care focused on the best outcomes for each of my patients."
"I love being a doctor and I encourage my patients to teach me how to be a better one."
"Practicing at Sharp Rees-Stealy has allowed me to devote my attention to providing quality care to my patients."
"I strive to provide friendly, compassionate care to my patients in a way I would want to be treated."
"The Sharp Experience means utilizing the doctor-patient relationship to motivate healthy lifestyle decisions — improving quality of life, health and longevity."