Complaints

This profile includes complaints for Security Health Plan's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Security Health Plan

  1515 North Saint Joseph Avenue Marshfield, WI 54449-1343

• 

  Security Health Plan

  PO Box 8000 Marshfield, WI 54449-8000

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:01/09/2025

  Type:Sales and Advertising Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 8/20/2023 my husband ******* "Buddy" ******* suffered a sever stroke. ******* is still unable to come home and is temporarily in a nursing home receiving physical, speech, and ********************. His doctors, nurses and therapists have all put in a recommendation for ******* to go to *** which is an in-patient rehab to obtain intense therapies (all 3). Again and again Security Health Plan has denied this request. This inpatient rehab would allow ******* to recover more quickly and come home. If SHP had even read his files and understood his medical situation they would agree that while ******* going to *** is additional cost it is in the BEST INTEREST of their member to attend *** for his recovery. *** has been negligent in regards to *******. I am requesting an IMMEDIATE THOROUGH review of his medical files and admittance into ***

  Business Response

  Date: 01/15/2025

  When we decide not to cover a service because it is not medical necessity, that decision is always made by a physician reviewer -- one of our medical directors.
  

  Our prior authorization review process includes three steps:
  1. Initial review: When a provider requests authorization for a service, the health plan reviews the request to determine if it meets criteria for medical necessity.
  2. Physician review: If the initial review suggests the service is not medically necessary, the case is forwarded to a physician reviewer.
  3. Final decision: The physician reviewer makes the final decision. If the physician reviewer agrees that the service is not medically necessary, we send a letter to the member and the provider telling them the service is not covered.
  
  Members always have appeal rights when it comes to decisions made by the health plan. If the health plan denies coverage for a service or stops a service a member thinks should be covered, a member can appeal the decision. This is known as a "request for reconsideration."
  
  If the plan does not decide in the members favor, the appeal will automatically be forwarded to an independent entity for an additional review. This is called a Level 2 appeal. If a member is still not satisfied with the decision of the Level 2 appeal, they may be able to continue through additional levels of appeal (Levels 3, 4 and 5).