Here to help
Patient resources
Your care, made clearer
Information to help you better understand your coverage and your rights as a patient.
What is an MSO?
LSMA is a Management Services Organization (MSO): a company that handles the administrative and operational side of running a medical practice, so your doctor can focus on you. Think of us as working behind the scenes to keep things running smoothly.
When you have questions about your care or coverage, your provider and health plan are always your best first contact. We’re here to support them.
Clinical guidelines
When your doctor makes decisions about your care (such as whether a test, procedure, or referral is appropriate), those decisions are informed by clinical guidelines set by your health plan, healthcare agencies, and documented best practices.
Clinical guidelines are developed using evidence-based medical research and are used by health plans to help ensure that care is safe, effective, and appropriate for each patient’s condition. Your provider uses these guidelines as one resource alongside their own clinical judgment when developing your treatment plan.
It’s important to note that clinical decisions at LSMA are made independently and impartially by your practitioner, free from financial pressure or administrative influence. Providers are never rewarded for denying, modifying, or limiting care, and no one involved in reviewing your care or coverage has a financial incentive (including through hiring, termination, compensation, or promotion) to do so. When a decision is made about your treatment, it is based on your clinical needs alone.
Our health plan partners
You have the right to review the guidelines that apply to your coverage. Below are links to the published guidelines for each of LSMA’s insurance partners. If you have questions about how a guideline may affect your care, speak with your provider or contact your health plan directly.
Anthem
Blue Shield
Health Net
Inland Empire Health Plan (IEHP)
Molina
UnitedHealthcare
Additional health guidelines
California Dept. of Health Care Services (DHCS)
CMS Medicare Coverage Database
WPATH
Other clinical criteria
In planning your care, your doctor may also refer to evidence-based care guidelines, industry insights, and best practices developed by an independent clinical guidance firm. You can view those guidelines via their portal (registration and login required) or by contacting us at (888) 554-4562.
Access Instructions
- Click the link below and accept the disclaimer and terms and conditions.
- Complete the User Information form.
- Complete the verification process.
- Select the arrow icon to expand the desired content group.
- Select the guideline you wish to review.
Access care guidelines
Note: LSMA uses MCG care guidelines to help review medical necessity for health service requests. MCG care guidelines are the protected intellectual property of MCG. LSMA is not able to distribute them without the permission of MCG. MCG has provided a tool that allows LSMA members and prospective members to view relevant MCG care guidelines; however, you will not be able to print them.
