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Welcome to Ultimate's Satisfaction Survey About Our Decisions for Health Care 

If you or your doctor asked us to make a decision about covering a service or treatment in the past year, we want to hear from you. Your responses help us understand what we can do better and how to improve our processes.  Please answer the following questions as best you can.  Thanks in advance for participating in our survey.

 
 
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Information About You 
Today's Date: 
   Use format: mm/dd/yyyy
Your Last Name (optional): 
 
Your First Name (optional): 
 
   
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How easy were each of the following activities? 
Getting a referral to a specialist you thought you needed to see. 
 
 
 
 
Getting approval for equipment or devices your doctor said you needed. 
 
 
 
 
Getting labs, diagnostic or radiology tests your doctor said you needed. 
 
 
 
 
Getting permission from the plan to get procedures or surgeries your doctor said you needed. 
 
 
 
 
Getting approval from the plan to get medications your doctor said you needed. 
 
 
 
 
     
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How satisfied are you with each item below? 
The process you went through when asking us to make a decision about covering a service or treatment (Ultimate's referral and authorization process) 
 
 
 
 
 
How we keep you and your doctor informed about your request 
 
 
 
 
 
The amount of time it takes to get a decision about your request 
 
 
 
 
 
How our process and communication compares to other health plans 
 
 
 
 
 
    
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If you visited the hospital, please answer the following questions. Otherwise, please skip this section. 
Was the utilization review nurse who visited you in the hospital courteous and kind? 
 
 
 
Was the utilization review nurse who visited you in the hospital knowledgeable and accurate? 
 
 
 
Was the utilization review nurse who visited you in the hospital helpful regarding your discharge needs? 
 
 
 
Did you get a call from a Care Coordinator about your discharge needs when you left the hospital? 
 
 
 
Did your Care Coordinator remind you to get a follow-up appointment with your primary care physician and/or specialist? 
 
 
 
     
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Comments / Suggestions 
Finally, is there anything else you want us to know about regarding our Utilization Management process or staff? 
 

Thank you very much for participating in our survey.  Your answers will help us continue to improve the quality of the services we provide.