Care Choices strives to provide members with high-quality and affordable health care. 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.

Utilization Management Information Available

Utilization Management criteria are available upon request. Please contact:

Cheryl Freeman, RN, BS
Supervisor, Clinical Management
(248) 489-6882

Please note that the treating physician may contact the physician reviewer to discuss the denial decision and alternate care options upon notification of a denied service. Please call (877) 442-1181 and one of our Care Choices UM/UR nurses will be happy to coordinate the discussion.