A formal claim made by the Enrollee in writing, by telephone or by visiting your Insurer or the Health Advocate Office, requesting a solution be granted when a service has been denied or allowed on a limited basis. A service; reduction, suspension or termination of a previously authorized service; total or partial denial of payment for a service; not having received services in a timely manner; when First Medical has not acted on a situation according to the established terms, refusal of First Medical to let the Enrollee exercise his/her right to receive services outside the network