Who should I call if I have any questions about filing a complaint?

You can contact the Washington Office of the Insurance Commissioner at (800) 562-6900. The Office is open from 8:00 a.m. to 5:00 p.m. Monday through Friday.  For more information about the internal appeal or external review process, the Office provides...

What happens after the Office receives my complaint?

The Office will forward a copy of your complaint to your health insurer and request a response.[18] It takes approximately 30 days from the time your complaint is filed to receive a response from the insurer.[19] The Office will then review the...

How do I file a complaint?

If you are a Washington resident and your claim is denied after the external review process, you can file a complaint with the Washington Office of the Insurance Commissioner (“Office”). Complaint information. Your complaint should include the following information: The name,...

How long will the external review process take?

The external review process should take no more than 20 days after the external review organization receives the request for fully-insured plans and no more than 45 days for self-insured plans.[13] If you requested an expedited external review, the process should...

How do I request an external review?

You should submit your request for an external review to your health insurer within 60 days from the date that your insurer sent you the final decision.[10] You can find a sample letter for requesting an external review on page 29...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[7] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Washington law, you are entitled to request an external...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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