How we decide What Care to Cover

Priority Health works hard to make sure the decisions we make about your care are in your best interest. We want you to receive care that meets high medical standards, while making sure that it is the best care for the money. Managing the effectiveness and cost of health care together is called "utilization management."

The utilization management process

Some of the ways we manage your health care include:

• Our chief medical officer and physician committees carefully research and review new technologies for effectiveness before deciding on whether to cover them or not.
• We make decisions about your health care based only on appropriateness of care and service, as well as existence of coverage.
  
• We don't restrict doctors from talking with you about care options, regardless of cost. We want your doctors and health care team to talk openly with you.
• We track the care and services you have received.
• We do not reward doctors or other medical staff to deny you coverage or services.
• We do not offer financial incentives or rewards to anyone to deny you services.

Questions?
Contact us if you have questions about the utilization management process outlined above and how Priority Health decides to cover treatments and technologies for patients.  A Customer Service representative will contact a health management staff member to help answer your questions.
Contact Customer Service