1.
In the end, a physician always makes the determination when
service or payment requests are at variance with standards and guidelines, although,
we rely on the judgment and recommendations of
the attending physicians unless there is compelling
clinical evidence to the contrary.
2.
The Primary Care Physician Medical Director is best suited
for determining the most appropriate specialty
Physician consultants, framing the
specifics to be addressed and finally, assuring that the consultants’ findings
answer the questions posed.
3.
Our Primary Care Physician Medical Directors and Consulting Specialists
communicate with attending physicians on a peer to-peer
basis. These medically oriented partnerships serve to advocate
for members to get the right care at the right time by the right
providers, enhancing employee and dependent satisfaction.
4.
We utilize a holistic approach, addressing both physical and
behavioral etiologies of disease. This real world perspective is
particularly important as it can relate workplace productivity with
underlying stress related or mental/nervous conditions.
5.
As clinicians, our Medical Directors and Specialty Physician Consultants
often offer insights into high risk conditions, participate
in benefit/cost analyses and provide the rationale supporting
authorization of extra-contractual benefits, if warranted.
