Authorization decisions are based on several things:

• Clinical information provided
• Benefits and coverage of your health insurance plan
• Your health plan’s medical policies
• Use of the CPMG network of providers

Because it might be a concern, please know that CPMG utilization-management decision making is based only on appropriateness of care, services and existence of coverage. The providers or other individuals conducting utilization review for coverage or services are not compensated for denials and/or encouraged for barriers to care or services. Incentives are not used to reward inappropriate restriction of care.

Should you wish to see our policy statement, a copy of the Affirmative Statement can be found by clicking here.