Affirmative Statement

Golden Coast MSO, on behalf of its contracted IPAs and hospital groups, affirms that it encourages appropriate utilization of medically necessary member care and discourages under-utilization of services by the following statements:

• UM decision making is based only on appropriateness of care and services and existence of coverage

• Golden Coast MSO does not specifically reward practitioners or other individuals for issuing denials of coverage or service care

• Financial incentives for UM decision makers do not encourage decisions that result in under-utilization

• Providers and practitioners are not prohibited from acting on behalf of the member

• Physicians cannot be penalized in any manner for requesting or authorizing appropriate medical care

• Practitioners are ensured independence and impartiality in making referral decisions that will not influence: hiring, compensation, termination, promotion or any similar matters