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