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Provider Manual

Security Health Plan's Expectations of Providers

Last Updated on January 05, 2022
  • act in the best interest of members 
  • communicate fully with members regarding their illness, as well as diagnostic and therapeutic options available to them
    • ensure member has access to interpreter services as needed
  • refer members for specialty care or second opinions within the Security Health Plan provider network and obtain approval from the Security Health Plan medical director when care is necessary outside of the health plan network 
  • maintain awareness of Security Health Plan technology assessment and drug evaluation committee decisions to the extent possible 
  • participate in Security Health Plan utilization management and quality improvement initiatives, including allowing Security Health Plan reasonable access to member medical records 
  • recognize that there are multiple, well-accepted means of diagnosis and treatment for many conditions 
  • inform the medical director when Security Health Plan procedures or actions are perceived as threatening the health or well-being of the member 
  • recognize that conflict occasionally occurs between providers and Security Health Plan, or members and Security Health Plan, and that these should be resolved within the appeals process outlined in Security Health Plan documents 
  • understand that Security Health Plan does not deny patient care, but simply makes payment decisions based on the member’s coverage through Security Health Plan. Members have the right to appeal any decision made by Security Health Plan. Information on how to appeal a decision can be reqested by calling Security Health Plan's Customer Service at 715-221-9555.
  • communicate with members and Security Health Plan in a way that assumes that all parties are acting in good faith with the goal being the best care possible for the member 
  • recognize that Security Health Plan is obligated to develop policies and procedures on benefit administration and to administer these in a fair and consistent manner even though this occasionally results in denial of payment for individual members 
  • understand that Security Health Plan’s objective is to improve access to and quality of health care 
  • refrain from making comments or offering advice on payment or insurance coverage issues 
  • refer patients with payment or insurance coverage issues to Security Health Plan Customer Service Department at 1-800-472-2363