Specifically, how does utilization review (UR) affect my coverage?
UR is automatically included in your plan. UR can help you and your doctor determine the most cost-effective way to give you the care you need. A trained medical staff of UR physicians and specialists review and certify in advance, the medical necessity of certain kinds of care and treatment. UR affects your coverage only for those items on your certificate’s list of treatments and services requiring certification. If you fail to obtain certification for those the amount that is covered could be reduced. Your plan may require your call ahead of time for and request certification for certain procedures. Please review your certificate to determine whether or not certification is required.
