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Members

Landmark works with health insurance plans to manage their physical medicine benefits, including treatment by rehabilitation therapists, chiropractors, acupuncturists and physicians specializing in pain management and spine surgery. In this role we assist health plans in developing provider networks, processing claims, reviewing treatment utilization and measuring clinical outcomes. Your therapist or physician may tell you that he or she must seek “prior authorization” from us before treating you. Health plans contract with us to perform this role to insure that the treatment charged to you under your health insurance is “medically necessary.” As a general rule, treatment is “medically necessary” when performed to treat an acute condition resulting from disease or injury, as opposed to treatment given to maintain your current health status or to address chronic illnesses or conditions that further treatment will not materially improve. The term also means that there is not a more conservative treatment that could be expected to deliver similar results. If a simpler process would suffice, then the more complex treatment isn’t medically necessary.

We recognize that when making medical necessity determinations, reasonable clinicians can differ which is why we maintain a robust appeal process that you or your provider (with your consent) can access to have treatment decisions reviewed.

If you have questions about your health plan benefits or you are trying to locate a provider, please contact your health plan directly or visit their website.