Specific Clinical Criteria Information
Connecticut requires clinical criteria be available to members covered by a fully insured commercial plan, both upon request and online. Certain clinical criteria used by Optum are developed and owned by third parties, including the American Society of Addiction Medicine (ASAM) and the American Academy of Child and Adolescent Psychiatry (AACAP). Because we do not own these specific criteria and these criteria are not in the public domain, access is limited to members who received an initial adverse determination based on these third-party criteria.
Your adverse determination (denial) letter may allow online access to these criteria. If allowed, there will be an alphanumeric (letters and numbers) code that is unique to your decision in the paragraph that lists the criteria used.
Remember, you are only authorized to access the third-party criteria to review the basis of the determination. You may not copy these criteria in whole or in part in any format or medium without the prior written consent of the American Society of Addiction Medicine (ASAM) or the American Academy of Child and Adolescent Psychiatry (AACAP).
Of course, if you would like a copy of the criteria, you can also call us at the number listed on your adverse determination letter.
Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
“AACAP” and “American Academy of Child and Adolescent Psychiatry” are registered trademarks of AACAP and are used with permission. Use of these terms is prohibited without permission of AACAP. Use of these trademarks does not constitute certification or endorsement of this product, practice, or action by AACAP. The American Academy of Child and Adolescent Psychiatry does not accept liability for clinical judgment and/or clinical decisions made through use of this instrument, as intended or for any other use, and shall not be liable for any special, incidental, consequential, punitive, exemplary, or other indirect damages, howsoever caused, whether arising in contract, tort or otherwise, in connection with its use or implementation.