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WellChoice's medical directors are available to discuss medical necessity denial decisions with physicians. To speak to a medical director, refer to the denial notification. It includes the medical director's name and telephone number.
WellChoice is committed to providing access for the delivery of quality medical care and services to its members. The Medical Management department shares the commitment by
- making utilization management decisions based only on the appropriateness of care and service, existence of coverage.
- not rewarding our medical staff-or other people who perform medical management functions-for denials of coverage for medical care and services
- having no financial incentives to encourage decisions that could result in underutilization.
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