The goal of the referral process is to ensure that patients are provided with an appropriate level of care, and that:
- Authorized, quality care is offered in a timely manner
- Authorized care matches the benefits defined by the patient's health plan
- Services are medically necessary
- Guidelines, standards of medical practice and criteria set by governmental and other regulatory agencies are adhered to and followed
- Referral decision-making is based only on appropriateness of care and service and evidence of insurance coverage
St. Joseph Hospital Affiliated Physicians publicly acknowledges that it provides health services to all members needing healthcare without consideration of race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or payment source.
Disclosure of Utilization Management Policy and Procedures and Criteria for Making Decisions
Upon request by a member, a person designated by the member, or by a member of the public, a copy of the requested material will be mailed to the requestor. The materials provided are guidelines used by St. Joseph Hospital Affiliated Physicians to authorize, modify or deny care for persons with similar illness or conditions. Specific care and treatment may vary depending on individual needs and the benefits covered under the individual's health plan.
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