ComplaintsforSelectHealth, Inc.

• Initial Complaint

  03/12/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  Good afternoon:We have a pre negotiated agreement amount for patients surgery dated 9.15.23 member number ***********, *******************. To date after many emails, phone calls, patient calls, the claim has still not been processed @ 65,000K. Can someone please process the difference, this is getting exhausting on all ends. Thanks The pre negotiated amount was sent several times with claims and via emails to ****.

  Business response

  03/21/2024

  March 21, 2024
  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests SelectHealth is refusing to pay a claim at the negotiated amount.  
  
  As of March 20, 2024, the claim has been adjusted and paid at the correct negotiated. We apologize for the inconvenience this has caused.
  
  If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  SelectHealth Appeals and Grievances

  Customer response

  04/01/2024

  Good morning, claim was paid last week, thanks!

• Initial Complaint

  03/08/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  We have been paying for health coverage in the ***************** over 3 months now. Select Health informed me they were new to the market and still uploading available doctors to their website. That was 3 months ago. My wife set up an appointment to see a gastroenterologist and they were confused on whether or not we were covered. They asked my wife if my insurance card showed that Select health was part of another insurance that was listed on the card. My wife said no and they proceeded to say that it should be ok. We were called today because the doctor is now saying we are not covered. I called select health today and told her everything and she pulled that same doctor up and says it is an in-network provider. I pulled up the list of providers and the doctor was not on there. The customer service rep said that the info must not have been loaded up to the website yet but she could see it on her end. When I called a month ago for the same issue, the rep told me that they have an email from corporate stating that Advent (the hospital in my town) is in network and they are still uploading the doctors. I have been paying for 3 months and I still can't see what providers are available to me! My wife has to be screened for colon cancer, esophageal cancer and pancreatic cancer ever single year because she is high-risk. I need to be able to get her the appointments she needs and are part of my network when she needs it. I don't understand how an insurance company can take payments when we can't even use the product we are paying for

  Business response

  03/19/2024

  March 19, 2024
  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests Select Health needs to finish adding all in-network providers to the online provider search.   
  As ******** is a new market with Select Health, the provider network is actively growing and it takes time to contract with providers. Select Health is actively working to get these providers displayed in the on-line directory. If any member needs help finding an in-network provider or setting up appointments they may contact our Advocates department.
  
  If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  Select Health Appeals and Grievances

  Customer response

  03/19/2024

   
  Complaint: 21405960
  
  I am rejecting this response because:
  Nothing was done to remedy the issue. I spoke to the regional manager and he informed me that because select health is new to ******** and I won't have access to looking for providers unless I call a provider and ask if they are part of the network. Also, the provider we selected was in network but we were told the facility he works at is not. All I want is to be able to get health care when I need it. I pay over $700/ month and I shouldn't have to ask 3 people if I'm covered. 
  Sincerely,
  
  *****************

• Initial Complaint

  02/28/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I bought this home in June of 2023. The previous owners is *****************************. We continue to get mail from Select Health for ******* and ***************************. We have wrote not at address, return to sender, and continue to get this mail. I called their customer service, and they didn't care. They said they can't stop mail unless it is the customer changing the address. They told me to throw away the mail. I feel harassed since I receive mail multiple times per month from them.

  Business response

  03/07/2024

  March 7, 2024
  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests Select Health is harassing them by sending communication meant for a previous homeowner.  
  
  In general, it is the responsibility of a member to update their address and other demographic information. However, Select Health was able to contact the policy holder and we have updated the mailing address. We apologize for any inconvenience the complainant experienced.
  
  If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  Select Health Appeals and Grievances

• Initial Complaint

  02/25/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  In 2023 and 2024 I received multiple physical therapy treatments at Intermountain Physical ************************** ****************, a facility that is in-network with Select Health. For 2023 I had 20 covered physical therapy appointments with no co-pay; for 2024 I had 20 covered physical therapy appointments with a $10 co-pay.After traditional physical therapy exercises exacerbated my condition and made the pain I experience on a daily basis much worse, the physical therapist suggested a different treatment approach, which I was open to trying. At no point did the physical therapist suggest or provide any documentation that this procedure might not be covered by my insurance, nor did I find any information in my policy that this procedure was not covered. I was never provided with a Good Faith ******** (GFE) to let me know what my out of pocket costs may be for this non-covered procedure, or any kind of estimate as to the out of pocket costs (this is a huge violation of my patient rights under the No Surprises Act). I did not know this procedure was not covered until Select Health denied all of my claims for these physical therapy appointments due to the non-covered CPT codes left me with huge bills that I'm not able to afford. I have contacted Select Health multiple times. The first time I spoke with a representative named ****** who initially seemed helpful and willing to work with me to find a solution. The last communication I received from this representative was a voicemail stating that Select Health refuses to pay for the non-covered codes and to contact the provider's office to ask for a write-off or a self-pay rate. I did so and the provider's reply was dismissive and full of gaslighting. So basically no one is willing to find a resolution to this situation, even though my patient rights were blatantly violated by not being provided an estimate of my out of pocket costs for something that wasn't covered.

  Business response

  03/07/2024

  March 7, 2024
  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests Select Health is refusing to pay for services recommended by their provider.
  
  Services that are experimental and/or investigational are not covered. A recommendation, order, or referral from a provider or facility does not guarantee coverage by Select Health. The services in question are considered experimental and/or investigational. According to our records, the complainant has filed an appeal which is currently being reviewed. Once a determination has been made, we will respond to the member directly.
  
  If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  SelectHealth Appeals and Grievances

• Initial Complaint

  02/21/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On 2.20.24 I received letters informing me that my policy has been cancelled due to non payment. This payment was scheduled for 12.1.23. I called them and spoke with a representative on 2.20.24 to find out how a policy on automatic payments get cancelled without at least a phone call and no notice. She told me they did do that to me and she didn't know why. I asked for a manager/supervisor and was then put on hold for 20 plus minutes before hanging up without speaking to anybody else. I didn't have the ability to stay on hold any longer. My other issue is in 2 of these letters, I am told to pay a total of $270.52, my premium was only $212. I'm still trying to figure out why they did not contact me when my card declined to collect payment. I never had consistent access to the online portal and in November 2023 all access attempted failed. I was never able to access the online portal again and didn't have the time to call every time it didn't work. Without a call or physical paper mail I would have had no way of knowing this was happening.

  Business response

  02/29/2024

  February 29, 2024
  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests Select Health cancelled their policy without any notification.
  
  The members policy was terminated due to non-payment of premium. Select Health is willing to work with the complainant to reinstate the policy back to the month of December 2023. The complainant has 30 days to contact our ************************** to make the necessary premium payment by credit card. 
  
  The complainant may call Premium Billing at ************ or ************.
  
  Sincerely,
  
  SelectHealth Appeals and Grievances

  Customer response

  02/29/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  02/15/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Subject: Formal Complaint against SelectHealth for Non-Payment of Commission Dear BBB,I am writing to file a formal complaint against SelectHealth regarding the non-payment of my commission.I entered into a commission agreement with SelectHealth, a health insurance provider, which entailed selling their insurance policies to potential customers. The agreement specified that I would be *********** a commission payment for each policy sold. I have fulfilled my responsibilities under the agreement by successfully selling several policies to eligible customers during the agreed-upon period.However, despite fulfilling my obligations, SelectHealth has failed to honor their financial commitment by withholding my earned commission. I have contacted their designated representative multiple times via email and phone calls, inquiring about the payment status and requesting clarification. Regrettably, these attempts have been met with silence and a lack of response from the company.Considering the ongoing lack of communication and the unjust withholding of my commission, I find it necessary to escalate this matter to your esteemed organization. It is evident that SelectHealth's conduct is both unprofessional and a violation of our agreement. I kindly request your intervention in resolving this dispute and ensuring that SelectHealth fulfills their contractual obligations.I seek the following resolution:1. Prompt payment of the commission owed to me. 2. Assurance that SelectHealth will adhere to the commission payment terms outlined in our agreement moving forward.3. Appropriate penalties or compensatory action against SelectHealth in order to deter similar actions in the future.I appreciate the BBB's dedication to addressing consumer concerns and ensuring fair business practices. I eagerly await your prompt assistance and a resolution to this matter.Sincerely,*********************

  Business response

  02/23/2024

  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests Select Health has refused to pay their commission.  
  
  Commissions are payable in accordance with ******** laws,rules, and regulations. If an agent allows their insurance license to lapse for any period of time, the agent is not eligible to receive commissions for policies sold during that particular month. This information is clearly documented in the agents contract with Select Health under Section 4.3 Continuously and Properly Licensed. To avoid this problem, Select Health sends notification to agents when the expiration of the appointment is approaching.
  
  In this specific case, although we sent notification of the upcoming expiration date of 12/31/2023, the agents license lapsed from 12/31/2023 through 01/17/2024 which affected the commission payment for policies sold in January, 2024.
  
  If the complainant would like to discuss this matter further, they may contact Select Health Agent Experience at ************ or by email at *******************************************.
  
  Sincerely,
  
  Select Health Appeals and Grievances

• Initial Complaint

  11/04/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I called Selecthealth Compliance Hotline at ************ a couple weeks ago to report possible fraud by a clinic that billed Selecthealth. The representative asked for my contact information but did not ask for any details. I never received a call back from Compliance to discuss the issue.

  Business response

  11/14/2023

  Select Health received the complaint and assigned it to an investigator who has been conducting some initial research. The complainant will be contacted before the end of the week.

  Sincerely,

  Select Health Appeals and Grievances

  Customer response

  11/14/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  11/01/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The business refuses to pay for my diabetic pump supplies even though they are covered under my healthcare plan through this business. When I called to resolve the issue they claim they have never heard of these parts or supplies and then they hang up on me.

  Business response

  11/13/2023

  Thank you for the opportunity to respond to this complaint. The complainant suggests Select Health refuses to pay for diabetic pump supplies.  
  
  Select Health has not denied any claims for diabetic pump supplies in this case. During a call with Select Health, the complainant stated they need a 7-day diabetic infusion kit instead of 3-day diabetic infusion kit that the durable medical equipment (***) vendor they use did not have. The complainant was given the names of other in-network vendors to contact about a 7-day diabetic infusion kit. Diabetic supply kits may vary between *** vendors.If the complainant needs a different item, brand, supply kit, etc. they should work with the *** vendor directly. If the *** vendor or complainant needs to verify benefit coverage they may call ****** Services.  
  
  If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays,from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  Select Health Appeals and Grievances

• Initial Complaint

  06/18/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My profound disappointment with SelectHealth's repeated refusal to cover ******** (Tirzepatide) for my type 2 diabetes cannot be overstated. As a life-saver, ******** is supported by scientific evidence as an effective treatment for this chronic disease threatening my health and quality of life.I have made numerous appeals to SelectHealth, providing comprehensive evidence demonstrating ********'s necessity and superior efficacy - supported by clinical trial data, my health records, and my physician's expert opinion. These efforts have repeatedly met with denials, devoid of satisfactory explanations or acknowledgement of the presented specifics.Dr. *********************, my physician, prescribed Mounjaro due to its dual-action mechanism for superior glucose control and additional potential benefits.My most recent appeal underscored ********'s importance for both my diabetes management and potential positive effects on my mental health and overall well-being, often overlooked factors. I requested a review by a specialist in endocrinology and diabetes management, a crucial step for an informed decision.Yet, SelectHealth's persistent denials have caused significant distress, forcing me to rely on ineffective treatment options, leading to severe diminishment of my life quality. This action demonstrates a disregard for their duty of care towards me, a trusting subscriber, as they deny access to essential medication, thereby endangering my diabetes management and long-term health.I am hopeful that your involvement might persuade SelectHealth to reconsider their decision, approve the much-needed Mounjaro coverage, and enable effective management of my condition, significantly enhancing my quality of life.I firmly believe that it's only with this step that my fight against diabetes can attain a favorable outcome. This complaint isn't just a request, it's a plea for an improved quality of life that has been denied for too long.

  Business response

  06/26/2023

  June 26, 2023
  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant suggests SelectHealth should cover the drug, ********.
  
  Not all drugs are covered by SelectHealth. A 'formulary' is a list of drugs covered by a members plan. Drugs not on the formulary are an exclusion of the plan. Mounjaro is not on either formulary, RxCore or RxSelect, offered through SelectHealth. When a specific drug is not covered, we encourage the patient to discuss covered alternatives with their physician. Covered alternatives for Mounjaro include but are not limited to: Soliqua, Trulicity, Bydureon, and ******. Please note, the covered alternatives for Mounjaro may require preauthorization or have step therapy requirements.
  
  While we understand this may not meet the members desired outcome, we have an obligation to consistently administer the plan. If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays,from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  SelectHealth Appeals and Grievances

• Initial Complaint

  05/13/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have select health insurance, live in ************** & injured my knee in *****. I called my doctor in ************** and he ordered & *** to be done at Cassia intermountain health (IHC) hospital in ****** so I could get the contractual discount with an 'in network' provider (select health is IHC'S insurance provider). I checked the online cost estimator on select health's 'my health' patient portal and there was no cost estimate provided for any IHC facililty in ***** for this ***. I called select health to get an estimate and was told I couldn't get one over the phone and they would email me a cost estimate within 3 days. No cost estimate was ever emailed to me within those 3 days and being in a lot of pain and unable to travel back to salt lake, I had the *** done at Cassia IHC hospital. Select Health only gave me $117 in network contractual discount for having this done at this IHC facility for a final cost of $2200. If i had the same procedure done at an IHC facility in **************, my cost would have been $474 after the contractual in network discount. I would have gone to a non IHC facility in ***** and paid a $500 cash price for the *** had I known this information beforehand. I called and wrote select health customer service multiple times and was told it was a billing issue. I called and wrote IHC billing several times and was told it was an insurance issue. Intermountain Healthcare's billing department gave me an additional $500 off 'courtesy credit' without admitting any fault which still leaves me with a final bill of $1730 for this ***. Intermountain billing is sending **************** that this bill will go to collections if I don't pay it now. I believe this is a clear violation of the 2022 health care cost transparency act as I tried via several avenues to get the cost estimate before having the *** done. My bill should reflect the standard in network select health discount for IHC facilities ($474 for this same *** at salt lake IHC facilities.

  Business response

  05/25/2023

  May 25, 2023
  

  
  
  
  Attn: Resolutions Specialist
  Accredited Business Services
  Better Business Bureau Northwest
  
  RE: Complaint ID# ********
  
  Dear Resolutions Specialist,
  
  Thank you for the opportunity to respond to this complaint. The complainant states they checked the online cost estimator for the cost of an *** at ************************ in *****; but was not able to get an estimate before the *** was performed. The cost of the *** was $2,200. They state if the same service had been done at ********************************* (TOSH) in **** the cost would have been much lower. If they had known the cost beforehand, they state they would have gone to a different facility and paid a discounted cash price. The complainant believes their bill should reflect the standard in-network discount for Intermountain Health facilities. The complainant also suggests SelectHealth is in violation of the 2022 health cost transparency act.
  
  The total cost of medical services can be impacted by the contract the facility has with SelectHealth, the billing codes, and the geographical location where the services occur. ************************ and TOSH have separate contracts that have different contracted rates and pricing.
  
  Cost estimates are not a price guarantee for any service and the total cost to the member may be different once the claim is submitted to SelectHealth. The cost estimator is located on the SelectHealth member portal.When an individual accesses Change Healthcare, the cost estimator, the page states:
  
  Change Healthcare is a cost transparency solution that provides pricing information on some medical services and prescriptions. This information is intended to be an estimate of the total amount you may expect to pay for the prescription or service, and is not guaranteed at the point of care. Change Healthcare does not provide medical advice. You should always consult with your doctor about changes that impact your health or for diagnosis and treatment of all medical conditions. Medical benefits coverage cannot be bound via this site. In all cases, your eligibility and benefits will be determined in accordance with and subject to the applicable plan document.
  
  The complainant states they were unable to access an estimate on the cost estimator; so, they called SelectHealth to get an estimate and was told it would be emailed within 3 days. We have reviewed the call notes and the first record of a call about the cost of an *** was not until after the claim was processed. During the review of this complaint, we checked the cost estimator for the location of ******, *****. We found that estimates for a lower extremity *** are available.
  
  The cost of an *** at ************************ and TOSH are different. When the claim in question was submitted it was processed correctly according to the contracted rate for the services received. As a result,an adjustment will not be made. If the complainant would like to discuss this matter further, they may call ****** Services at ************ weekdays,from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users, please call 711.
  
  Sincerely,
  
  SelectHealth Appeals and Grievances

  Customer response

  05/25/2023

   
  Complaint: 20055672
  
  I am rejecting this response because: There was no transparency in the cost of this procedure available to me before having it done. ************************ is an intermountain healthcare facility. There was no cost estimate for this hospital available for this hospital for any procedure when I checked the cost estimator on select health's website. I called select health for a cost and none could be provided. I was told one would be emailed to me within 3 days but none was ever sent. The same procedure done at Intermountain healthcare facilities in **** is under $500 with the in network discount. I went to Cassia and was charged over $2000. If i had known this, I would have gone to a non intermountain healthcare network facility in ***** and paid a cash price which would have been around $500. No one is taking responsibility- neither select health, ************************ or Intermountain Healthcare. I still believe this is a violation of the healthcare cost transparency act. I tried in good faith to find a price before having the procedure done but as I was in a lot of pain and unable to travel back to ****, I had the procedure done in ***** (unfortunately for me at Cassia).
  
  Sincerely,
  
  ***************************************

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