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Financial Compensation – Providers Make the Decisions

Coventry’s utilization management program helps ensure that our members receive medically necessary healthcare services in the most cost-effective setting according to their benefi t package.Working with the member andthe physician, we evaluate services for medical appropriateness, timeliness and cost. Our decisions are based exclusively on appropriateness of care and serviceand the existence of coverage. We do not compensate or reward practitioners,employees or other individuals for denying coverage or care. In addition,Coventry does not use incentives to reward inappropriate restrictions of care.

New Technologies

Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device. The Plan has processes on how to review and judge new technologies.

When we find out about new technology, we carefully review the latest information. We may also ask experts for their opinions. We compare the information with well-known standards and base all of our decisions on making sure you have the right care and services.

Complaints and Appeals

Our complaints and appeals policies help us make sure we correctly handle, record and solve complaints or appeals.

The Complaint process gives you the right to tell us you are not happy with us or to ask us to review anything about:
 

  • Quality of Health Care Services
  • Covered Services
  • Member Rights and Responsibilities
  • Care after hours

The Appeals process lets you ask us to review:

  • Issues about Health Care Services
  • Medical Necessity of Services
  • Services that are denied or reduced


Locate contact information on the Contact Us page

  • Toll-Free customer service numbers
  • Hours of operation
  • Teletypewriter (TTY) numbers
  • Physical or post office box addresses

Locate plan benefit information by searching and viewing plan details on our Online Plan Finder or review the plan’s benefit documents on the Member Benefits page.
  • Cost sharing (coinsurance or copayment) information
  • Premiums
  • Deductibles
  • Summary of Benefits document
  • Evidence of Coverage document

Locate prescription drug information
Locate Grievances & Appeals information
Locate information for extra help
Locate additional information

Page Last Updated: 08/27/2014
CMS Approved Date: Approved 02/08/2013
CMS Document ID: Y0022_PDPCCP_2013_4006_1202b

© Copyright 2008-2014 Coventry Health Care

Coventry Health Care is a Coordinated Care plan with a Medicare contract. First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plans depends on contract renewal.