Episode 23

Behind The Care: What is Utilization Review?

Watch Now

Listen Now

Episode 23

We look under the hood of addiction treatment services and what Utilization Review (UR) is, and why it is so important for families to be knowledgeable about it.


What Utilization review is and how it is beneficial to families and individuals seeking addiction treatment

Levels of care within addiction treatment and how the process of utilization review makes sure the individual gets the recommended level of care (LOC) treatment stay through the insurance coverage

The reasons why insurance companies sometimes won’t support, or provide coverage for the length of stay recommended by treatment providers

How Utilization Review is saving lives

Select Quotes

Time in treatment saves lives, and time in treatment comes through good utilization review, and good utilization review simply means leaving no stone left unturned, understanding fully what an insurance company’s criteria is, looking at a client’s clinical presentation before making that request and advocating on behalf of the client. And if that means reaching out to the provider’s office to get more information, or if that means I have to go in and look through years of cases to find a similar case where they were able to give us more time, and also fighting on the phone for these clients. Of course, it’s diplomatic, but at the end of the day we are on the phone and we are pulling for every single day possible leaving no inches on the field because one extra day in treatment can be the difference between life and death. We fully understand that and we take it with a huge responsibility.
Christian Pantoja, Founder & Executive Director of Pantoja Consulting LLC

Episode Transcripts