Neighborhood has a special team of nurses and clinical staff. This team reviews requests for hospital admissions and other treatments. The process is called utilization management (UM). Our UM decisions are based on what is right for our members and what is covered. We want to make sure members receive the best health care possible.
Neighborhood does not reward anyone who makes UM decisions with money or other incentives for denying or limiting services to members. Neighborhood does not give financial rewards for UM decisions that result in fewer services or less care. If you have questions about how Neighborhood makes care decisions, call us at 1-800-459-6019.