Common use of Our Right to Conduct Utilization Review Clause in Contracts

Our Right to Conduct Utilization Review. To be sure a member receives appropriate benefits; we reserve the right to do utilization review. We also reserve the right to contract with an organization to conduct utilization review on our behalf. If another company does utilization review on our behalf, the company will act as an independent contractor. The company is not a partner, agent, or employee of Blue Cross & Blue Shield of Rhode Island. This agreement provides coverage only for medically necessary care. The determination, by an entity conducting utilization review, whether a service is medically necessary is solely for the purpose of claims payment and the administration of your health benefit plan. It is not a professional medical judgment. Although we may conduct utilization review, Blue Cross & Blue Shield of Rhode Island does not act as a health care provider. We do not furnish medical care. We do not make medical judgments. You are not prohibited from having a treatment or hospitalization for which reimbursement has been denied. Nothing here will change or affect your relationship with your provider(s).

Our Right to Conduct Utilization Review. To be sure ensure a member receives appropriate benefits; , we reserve the right to do conduct utilization review. We also reserve the right review or to contract with an organization to conduct utilization review on our behalf. If another company does performs utilization review on our behalf, the such company will act as an independent contractor. The company is contractor and not a partner, agent, or employee of Blue Cross & Blue Shield of Rhode Island. This agreement provides coverage for only for medically necessary care. The determination, determination by an entity conducting utilization review, review of whether a service is medically necessary is solely for the purpose of claims payment and the administration of your health benefit plan. It , and is not a professional medical judgment. Although we may conduct utilization review, Blue Cross & Blue Shield of Rhode Island does not act as in the capacity of a health care provider. We do , does not furnish medical care. We do care and does not make medical judgments. You are not prohibited from having undergoing a treatment or hospitalization for which reimbursement has been denied. Nothing here will change , and nothing herein shall alter or affect your relationship with your provider(s).