Actions, Appeals, and Grievances
If you have a concern or complaint after a Select Health Action, you can file an Appeal or Grievance. Read more about each one to decide which one best meets your needs.
What is an Action?
An Action is when Select Health:
- Denies care or approves less care than you wanted
- Denies a covered service you have had
- Lowers the number of services you can get or ends a service we approved
- Denies payment for care that you may be responsible to pay for
- Does not take care of an Appeal or Grievance as soon as we should
If you have a problem with an Action we have taken, call Member Services. They can solve most problems. If you are unhappy with how things work out with Member Services, you can file an Appeal or Grievance.
What is an Appeal?
An Appeal is when you write and ask us to review an Action we have taken to see if we made the right ruling on your claim. See our Appeal form or contact Member Services at 800-538-5038 for help preparing an Appeal.
You’ll have 90 days from the date we take action to ask for an Appeal. If you need help with an Appeal, call the Appeals department at 844-208-9012. We have interpreters and help for those with hearing problems.
What is a Grievance?
A Grievance is a complaint about anything other than an Action. Some Grievances are:
- 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 member rights or discriminated against
See our Grievance form or contact Member Services at 800-538-5038 to file a verbal Grievance.
Learn more about Appeals and Grievances in the CHIP Member Handbook.