Appeals & Grievances

What is an adverse benefit determination?

Generally speaking, members are issued an Adverse Benefit Determination when a benefit is denied or coverage is rescinded. If you’ve received notice of an Adverse Benefit Determination, you have 60 days to ask for an appeal.

If you need help filing an appeal, please call the Appeals and Grievances department at 844-208-9012. Foreign language interpreters are available, and we offer assistance for those with hearing problems.

Understanding Adverse Benefit Determinations

An Adverse Benefit Determination is when Select Health:

• Denies care or approves less care than you wanted
• Denies a covered service you've had access to previously
• Lowers the number of services you can get or ends previously approved service
• Denies payment for care that you may be responsible for paying
• Does not take care of an Appeal or Grievance as soon as we should

If you have a problem with an Adverse Benefit Determination, please call Member Services. They can help you work through most problems. If you still need help or have additional questions, you can file an appeal or grievance

What is an appeal?

An appeal is a request to review an Adverse Benefit Determination. Essentially, you ask that we double-check our decision to make sure we made the correct ruling on your claim. 

What is a Grievance?

A Grievance is a complaint about anything other than an Adverse Benefit Determination. You can file a grievance at any time. Examples of grievances include:

• The quality of care you received
• A doctor was rude to you
• Your rights were not respected by a Select Health staff member
• A doctor won’t see you in a reasonable amount of time
• You were not treated fairly, or you feel you were denied your rights or discriminated against

Fill out a Grievance form or contact Member Services at 800-538-5038 to file a verbal Grievance.