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Golden Rule Insurance Company fax number
(801) 478-7595
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Grievance Administrator
Used for: Health care appeals/grievances for adverse determinations on health care services (appeal process for denials, reductions, or coverage issues).
Fax destination details
- Department
- Grievance Administrator
- Purpose
- Health care appeals/grievances for adverse determinations on health care services (appeal process for denials, reductions, or coverage issues).
- Form
- 33570-G — HEALTH CARE APPEAL REQUEST FORM
- Address
- Grievance Administrator, Golden Rule Insurance Company, PO Box 31379, Salt Lake City, UT 84131
- Voice phone
- 1-800-657-8205
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Use this form to tell your insurer you want to appeal a denial decision; include the decision being appealed, supporting documentation, and any expedited-certification from the treating provider if requesting expedited review.
Official form instructions are published as a downloadable file on the organization's website.
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