Confluence Health requires that all utilization-related decisions regarding member services be based on appropriateness of care and service. Financial rewards or incentives must not influence any utilization decision. No rewards or incentives are issued by Confluence Health that may discourage appropriate care and services to its patients/members. Under-utilization is to be avoided whenever possible.
We do not reward practitioners, providers or employees for issuing denials of coverage or service. All denials must be based strictly on insufficient medical appropriateness or not a covered benefit.