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Sanford Health Plan

Utilization Management Criteria

Utilization Management (UM) decision making is based only on appropriateness of care and service and existence of coverage. Sanford Health Plan does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service care.

Any financial incentives offered to UM decision makers do not encourage decisions that result in under-utilization and do not encourage denials of coverage or service. Decision makers sign an “Affirmative Statement Regarding Incentives” verifying the above conditions.

Utilization Management criteria are available by contacting Utilization Management between 8 a.m. and 5 p.m. Monday through Friday CT, at (800) 805-7938 or emailing at utilizationmanagement@sanfordhealth.org

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Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

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Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

Sanford Health Plan offers two different provider network products in your area. Select what option that best fits your needs.

Click here to search our provider directory. If your doctor does not display, they most likely are not a participating provider with Sanford Health Plan. Feel free to continue the Plan Picker tool if you are still interested in what options Sanford Health Plan has to offer. If not, we appreciate you using our Plan Picker!

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