July 27, Attn: [redacted] Revdex.com Resolutions Consultant PO Box DuPont, WA Re: Complaint ID: [redacted] Dear Ms [redacted] : This letter is in response to the complaint filed by a SelectHealth member regarding denial of a requested medication In the complaint, the member asserts that SelectHealth is denying coverage of a medication prescribed by his/her physician and is forcing the patient to try several other drugs before approving the requested medication Some drugs have special requirements that must be met before SelectHealth will cover themThere are certain drugs that require preauthorization to be covered by SelectHealthAdditionally, certain drugs require a provider to first prescribe an alternative drug preferred by SelectHealthThe alternative drug is generally a more cost-effective therapy that does not compromise clinical qualityThis approach is known as step therapyIf a provider believes a patient requires a certain medication that normally requires step therapy and feels that the alternative drug does not meet the patient’s needs, the provider may request an exception through the preauthorization processSelectHealth may cover the drug without step therapy if determined to be medically necessary Furthermore, if a member disagrees with a decision made by SelectHealth, he/she has the right to appeal the decision in writing to the following address: SelectHealth Attn: Appeals Department PO Box Salt Lake City, UT Fax: 801-442- Thank you for the opportunity to respond to this complaintIf you have additional questions regarding this matter, please call me at 844-208- Sincerely, Emily [redacted] J [redacted] Appeals Manager SelectHealth
December 21, Accredited Business Services Revdex.com Northwest Re: Complaint ID: [redacted] To Whom It May Concern: This letter is in response to the complaint filed by a SelectHealth member regarding the termination of his/her policy Individual plan members may terminate their plan by giving SelectHealth advance written noticeGenerally, the termination date is the end of the month in which the termination event or request occursHowever, SelectHealth may terminate coverage for nonpayment of applicable premiums or contributionsTermination may be retroactive to the beginning of the period for which premiums or contributions were not paid, and SelectHealth may recover the amount of any benefits a member received during the period of lost coverage The member in question asserts that the policy was erroneously terminated on June 30, Our records indicate that the member’s July premium was not receivedOn July 15, 2016, a letter was mailed to the member with notification that the premium was late, with instructions to pay the applicable premium before the last business day of JulyThen, on July 18, 2016, the member submitted a change form to add a newborn dependent childWhen a dependent is added to the plan, the premium rate is increasedOn July 25, 2016, the member also submitted a request to terminate the dental benefits for the dependents covered by the planTerminating the dental benefits also changes the premium rateWhile the member suggests a request to terminate the medical benefits was also submitted, there is no record of that request This member uses online billing to make premium paymentsBecause of the multiple changes to the policy, multiple billings with the change in premium for the medical benefits were sent to the memberBecause no payment was made for July the plan terminated June 30, for non-payment of the applicable premium If the member has further questions regarding this matter, please contact me at 801-442-(Salt Lake area) or 844-208- Sincerely, Emily NJ [redacted] Appeals Manager SelectHealth
July 27, Attn: [redacted] Revdex.com Resolutions Consultant PO Box DuPont, WA Re: Complaint ID: [redacted] Dear Ms [redacted] : This letter is in response to the complaint filed by a SelectHealth member regarding denial of a requested medication In the complaint, the member asserts that SelectHealth is denying coverage of a medication prescribed by his/her physician and is forcing the patient to try several other drugs before approving the requested medication Some drugs have special requirements that must be met before SelectHealth will cover themThere are certain drugs that require preauthorization to be covered by SelectHealthAdditionally, certain drugs require a provider to first prescribe an alternative drug preferred by SelectHealthThe alternative drug is generally a more cost-effective therapy that does not compromise clinical qualityThis approach is known as step therapyIf a provider believes a patient requires a certain medication that normally requires step therapy and feels that the alternative drug does not meet the patient’s needs, the provider may request an exception through the preauthorization processSelectHealth may cover the drug without step therapy if determined to be medically necessary Furthermore, if a member disagrees with a decision made by SelectHealth, he/she has the right to appeal the decision in writing to the following address: SelectHealth Attn: Appeals Department PO Box Salt Lake City, UT Fax: 801-442- Thank you for the opportunity to respond to this complaintIf you have additional questions regarding this matter, please call me at 844-208- Sincerely, Emily [redacted] J [redacted] Appeals Manager SelectHealth
December 21, Accredited Business Services Revdex.com Northwest Re: Complaint ID: [redacted] To Whom It May Concern: This letter is in response to the complaint filed by a SelectHealth member regarding the termination of his/her policy Individual plan members may terminate their plan by giving SelectHealth advance written noticeGenerally, the termination date is the end of the month in which the termination event or request occursHowever, SelectHealth may terminate coverage for nonpayment of applicable premiums or contributionsTermination may be retroactive to the beginning of the period for which premiums or contributions were not paid, and SelectHealth may recover the amount of any benefits a member received during the period of lost coverage The member in question asserts that the policy was erroneously terminated on June 30, Our records indicate that the member’s July premium was not receivedOn July 15, 2016, a letter was mailed to the member with notification that the premium was late, with instructions to pay the applicable premium before the last business day of JulyThen, on July 18, 2016, the member submitted a change form to add a newborn dependent childWhen a dependent is added to the plan, the premium rate is increasedOn July 25, 2016, the member also submitted a request to terminate the dental benefits for the dependents covered by the planTerminating the dental benefits also changes the premium rateWhile the member suggests a request to terminate the medical benefits was also submitted, there is no record of that request This member uses online billing to make premium paymentsBecause of the multiple changes to the policy, multiple billings with the change in premium for the medical benefits were sent to the memberBecause no payment was made for July the plan terminated June 30, for non-payment of the applicable premium If the member has further questions regarding this matter, please contact me at 801-442-(Salt Lake area) or 844-208- Sincerely, Emily NJ [redacted] Appeals Manager SelectHealth