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My Health
Utilization Management (UM) is a process that
helps decide if certain outpatient care services,
inpatient hospital stays or procedures are medically
needed and covered by the plan.
Decisions are only based on what is right for each
member, based on the type of care and service. We
look at standards of care taken from:
•
Medical policies.
•
National clinical guidelines.
•
Your health benefits.
You should know:
•
Employees, consultants or other providers
are not rewarded or offered money or other
incentives to deny care or service.
•
They are not rewarded for supporting decisions
that result in the use of fewer services.
Notice of Privacy Practices
We care about your privacy. Our Notice of Privacy
Practices tells you how we keep your information
private. It also tells you what rights you have to see
and manage your information. To learn about your
privacy rights, follow these steps:
❯
❯
Go to
anthem.com/ca
.
❯
❯
At the top of the screen, click on
State Sponsored
.
❯
❯
Choose
Medi-Cal
.
❯
❯
Choose
Notice of Privacy Practices: Medi-Cal
and L.A. Care.
How do we decide if we’ll cover a
treatment, procedure or hospital stay?
We use our Utilization Management process
•
We do not make decisions about hiring,
promoting or firing these people based on the
idea that they will deny benefits.
To learn more about UM or a case, call us toll-free
from 8 a.m. to 5 p.m. weekdays, except holidays,
at
1-888-831-2246
. If you would like to talk to
someone in a language other than English, ask for an
interpreter in your language. If you have hearing or
speech loss, call the TTY line at
1-888-757-6034
.
If you call at any other time, you can leave a private
message. Our staff will return your call on the next
business day during the hours above. Or you can
ask that someone call you back at a different time.
Any staff members who call you about a UM issue
will give you their name and title and the name of
the company.
New treatments and procedures
Helping you get care that
is safe and right for you
When it comes to the latest information about
medical care, we work to review it quickly. We
have teams of health care experts who review
medical, mental health and drug policies on an
ongoing basis.
We look at a variety of resources, including:
•
•
Medical journals.
•
•
Government policies and procedures.
•
•
Studies that show the effects of the new
technology on long-term health.
•
•
Doctors and other health care experts.
We update our health policies and even create new
ones to address many new treatments. Helping you
stay healthy is our No. 1 goal.
