This article is intended for HMO members enrolled in an employer health insurance plan.

We know you may have questions about your medical condition and how best to coordinate your care. Having access to utilization management (UM) staff can help you better understand your options.

UM is a tool that helps us make sure your care, services and benefits are right for you. UM decisions are based on medical need.

Our staff can provide the following services when you want information about the UM process and the authorization of care.

• Staff are available at least eight hours a day during normal business hours for inbound collect or toll-free calls about UM issues.
• Staff can receive inbound telephone, email and fax communications about UM issues. Communications received after normal business hours are returned on the next business day. Those received after midnight on Monday through Thursday are responded to on the same business day. 
• Staff give their names, titles and organization name when making or returning calls about UM matters.
• TDD/TTY services are used when a member has hearing or speech difficulties.
• For members who need language translation, the service is provided free of charge in the requested language through bilingual staff or an interpreter during business hours. (Language assistance doesn't apply when we are not making UM decisions about care, or if all services are automatically approved.)

The more information you have about your medical care, the better you can manage your care. Using the resources available to you can help.

If you have questions, call the customer service number on your member ID card.

Originally published 7/2/2020; Revised 2021, 2022, 2023