Security Health Plan Medicare Advantage Member Update

Welcome

This month’s update highlights common Medicare Advantage issues that may affect your care, prescriptions, provider access, and costs.

It explains what to watch for, which plan documents to review, and what steps to take if you have a question, concern, or service denial.

Featured Topic: Prior Authorization and Delays

Prior authorization may be required before certain tests, treatments, procedures, or medications are covered.

Security Health Plan may also require referrals or approvals for some out-of-network services. If you are unsure whether a service needs approval, contact Member Services before your appointment.

If coverage is denied or delayed, review the notice carefully and ask whether you may request a fast appeal if waiting could seriously affect your health.

Common Member Issues to Watch

• Provider access matters. Check whether your doctor, specialist, hospital, pharmacy, or facility is in-network before receiving non-emergency care.

• Prescription coverage can change. Review your formulary and pharmacy options if a medication moves tiers, needs prior authorization, or is no longer covered the same way.

• Extra plan perks may vary by plan. Benefits such as dental, vision, hearing, fitness, over-the-counter allowances, and other supplemental features should be reviewed in your plan materials.

Key Dates and Reminders

• Review your Evidence of Coverage and Summary of Benefits – These documents explain covered services, cost-sharing, limitations, and your rights as a member.

• Watch for your Annual Notice of Change each fall – This notice explains what may change for the next plan year, including benefits, costs, and coverage rules.

• Keep all coverage and denial notices – Save letters about claims, prescription decisions, referrals, and prior authorization so you can track deadlines and next steps.

Member Tip of the Month

Before a non-emergency service, ask:

• Is this provider in-network?

• Does this service need prior authorization or a referral?

• Has the request already been submitted?

You can also use your member portal to track claims, prior authorizations, and out-of-pocket costs.

Where to Get Help

• Call Security Health Plan Member Services using the number on your member ID card if you have questions about coverage, claims, referrals, or appeals.

• Ask your doctor’s office to help confirm network status, gather records, and submit supporting information for a prior authorization or appeal.

• Review your plan documents regularly, including your Summary of Benefits, Evidence of Coverage, provider directory, and formulary.

Appeals and Grievances

If you disagree with a coverage or payment decision, you have the right to ask for an appeal.

If you are unhappy with service, care quality, or another part of your plan experience, you can file a grievance.

If waiting for a standard decision could seriously harm your health, you, your doctor, or your prescriber may request a fast appeal.

Review your denial notice carefully because it explains the deadlines and steps for your situation.

Issue	Contact Details
Medical coverage questions or appeals	Member Services: 1-877-998-0998 (TTY 711)
Part D prescription drug coverage determinations	1-866-270-3877 (TTY 711)
Written requests	Security Health Plan, P.O. Box 8000, Marshfield, WI 54449-8000

What to do if you get a denial notice

• Read the notice the same day and look for the reason for the denial.

• Mark the deadline to appeal and keep a copy of the notice for your records.

• Call Member Services and your doctor’s office to ask what information may help support your appeal.

• Ask about a fast appeal right away if waiting could seriously affect your health.

Closing Note

Thank you for taking time to stay informed about your Security Health Plan Medicare Advantage coverage. Understanding your plan rules, reviewing your plan documents, and asking questions before care is delivered can make it easier to avoid surprises and get the care you need. If an issue comes up, act quickly, keep your records, and use the support available to you.

Disclaimer: This newsletter is intended as general member information and may not reflect every current plan detail. Members should review their current plan documents, including the Summary of Benefits, Evidence of Coverage, provider directory, and formulary, for the most up-to-date information.