At FOCUS, the patient’s needs are always our primary concern.  We have extensive experience working with nationally recognized, independently developed criteria and guidelines as well as Health Plan internally developed criteria, guidelines and policies.  However, patients are complex and no criteria set, guideline or policy could ever hope to fully address all possible aspects of the patients needs/symptoms, biopsycosocial context and/or the healthcare delivery system.  Because of that, our reviewers use their experience and expertise to look at the whole clinical picture to make a determination that is based independent clinical judgement and informed by the applicable criteria, guideline or policy.  We believe that the right care, that is medically necessary and appropriate, at the right time results in positive outcomes for everyone.