We provide for care that is shown to be safe and useful. We review new health care treatments. We review new procedures. The review uses up to date health data. This is called New Technology Assessment. We decide whether to pay for these things. This review means we pay when safety and value is clear. You may ask us to review new technology. The Texas Vendor Drug Program reviews medications.

Utilization Management Decisions

Community follows guidelines to determine what health care services we cover. This is called utilization management. We know how important it is that we make the right decisions for your care. Community follows three principles when we make these decisions:

1. Our decisions are based only on whether or not:
   • The care and services are appropriate
   • It is a covered benefit
2. We do not reward doctors or anyone else for denying coverage.
3. We do not give incentives to doctors or anyone else to encourage them to make decisions that would mean you would get less care than you need.
4. If Community denies your request for services, you can get an independent external review. An independent review is when someone not employed by Community reviews your request for services. This is called a Fair Hearing.

Quality Improvement

Our Quality Improvement Department helps Community give you the best clinical care and service possible. If you want more information about our Quality Improvement Program, please contact Member Services toll-free at 1.888.760.2600.

STD Information

If you need information about sexually-transmitted diseases (STDs) or Human Immunodeficiency Virus (HIV), please call Community’s Member Services at 713.295.2294 or toll-free at 1.888.760.2600.

Moral or Religious Objections

Community Health Choice does not exclude access to any services because of moral or religious objections.