Procedures and Criteria are Disseminated to Members Upon Request.
The materials provided to you are guidelines used by the medical group to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and benefits covered under your contract. Those are guidelines and do not constitute the standard of care.
For questions or concerns that are related to a referral that your provider has submitted, patients can telephone our main Utilization Management number, 818-837-5660. Hearing or speech-impaired members (TTY users) can call 711 relay services. Collect calls are accepted for patient referral matters, and Spanish speaking staff members are available.
If a patient wishes to file a grievance: contact one of our Patient Liaison Offices.