If the member's benefit plan does not require a clinical review and the service does not meet clinical guidelines, or if additional information is needed, we’ll let you know if you need to have a physician-to-physician discussion. When you notify us of a planned service that is subject to the protocol, we’ll conduct a clinical review to determine if the service is medically necessary and covered, and will let you know our decision. The following Commercial resource materials are inclusive of the UnitedHealthcare River Valley and NHP membership.
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