6.4 FAILURE TO FOLLOW REQUIRED UTILIZATION MANAGEMENT PROCEDURES * Very Important Information * If you don’t follow the required Precertification Review, Concurrent (Continued Stay) Review, or Case Management procedures, or if you undergo a medical procedure that has not been determined to be Medically Necessary under the Second Medical Opinion Program, the Administrative Office may refer your claim for Retrospective Review to determine if services were Medically Necessary. If it is determined that the services were not Medically Necessary, no benefits will be payable for those services. If it is determined that services were Medically Necessary, but the Utilization Management procedure was not followed, the Plan will pay only 50%, rather than 70%, of Covered Services. In other words, you pay more. By not following the Utilization Management procedure, you are responsible for 50% of the UCR charges, instead of 30%, and the difference between these amounts will not count towards the Plan’s calendar year deductible or the Annual Out-of-Pocket Limit.