Ensuring Appropriate Care and Service

Care Choices strives to provide members with high-quality and affordable healthcare. Staff who make utilization-related decisions promote appropriate utilization of care and service and are aware of the risks of under-utilization. Care Choices works to remove any barriers to care and service, and does not provide incentives to encourage utilization denials. In keeping with this policy, Care Choices acknowledges the following:

• Utilization decisions are based only on the appropriateness of care, services and the existence of coverage.
• Employees are not compensated for issuing denials of coverage or service.
• No incentives are offered to encourage decisions that result in under-utilization.