PacifiCare Behavioral Health, Inc. (PBH) makes utilization
management decisions based solely upon the appropriateness
of the care and service for its members. PBH does not offer
any incentives, financial or otherwise, as a reward for issuing
approvals or denials of care or limiting care such that barriers
to care or service are incurred or that under-utilization
of services results. Practitioners acknowledge and abide by
PBH's policies regarding utilization decision-making based
only upon Medical Necessity and the appropriateness of care
and services.
