Utilization Management

Utilization Management

YourCare Health Plan makes decisions regarding the provision of healthcare services based solely on the appropriateness of care and services and the existence of coverage.

YourCare Health Plan does not:

  • Pay any employee, consultant, provider, or independent contractor any financial incentive to deny care
  • Specifically reward practitioners or other individuals conducting utilization management  review for issuing denials of coverage or of care
  • Provide incentives for utilization management decision-makers that result in underutilization of appropriate services