Medical Management

What constitutes a covered service? How are "medically necessary" or appropriate lengths of stay defined?
What disease management programs are in place ? How do they affect a patient with an existing condition?
What preventive health care programs are in place, e.g., vaccines, immunizations, mammograms, health club membership reimbursement, etc.?
Are there other optional covered services? If so, which ones?
Can the plan provide HEDIS® data? If not, why not?
Does the plan have a quality assessment program in place?
Please explain internal or external appeals processes.
Is there a program in place to address medical errors?

HEDIS® is a registered trademark of the National Committee for Quality Assurance.