State agency ยท Washington State Office of the Insurance Commissioner
Washington Insurance Commissioner: appealing a health insurance denial
Washington's insurance regulator explains how to appeal a denial, which plans it regulates, and where to find sample appeal letters by denial reason. Consumer advocates answer questions and take complaints.
Know before you go
The page links to a how-to article, sample appeal letters, a chart for working out who regulates your plan, and a page on Medicare and plans the office does not regulate. The state file says the office regulates individual and fully insured group plans, not self-funded employer plans, Medicare or Apple Health (Washington Medicaid). In Washington you ask your insurer, not the state, to send your case for independent review. The hub page gives no deadlines, so use the dates on your denial letter.
- Cost
- Not stated
- Where
- Washington
- How to start
- Read the how-to article, then call the consumer advocates or use the Ask an insurance expert form. File a complaint online if the insurer broke a rule.
- Phone
- 800-562-6900, as printed on the provider's page
- Have ready
- Your denial letter; Your insurance card; Your plan documents; A log of calls and letters with your insurer
Where this comes from
- Provider
- Washington State Office of the Insurance Commissioner
- Source we read
- https://www.insurance.wa.gov/appealing-health-insurance-denial
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
AppealArmor
A free web tool that reads a photo or text of your denial letter, shows you what it read, and emails an appeal letter and a Next Steps sheet with where to send it and your deadline. It also has a deadline calculator.
From AppealArmor
- Program or service
California Independent Medical Review decision search
A searchable database of every California Independent Medical Review decision since 1 January 2001. Search by drug, treatment, therapy or condition to read how reviewers decided cases like yours.
From California Department of Managed Health Care
- Program or service
Crohn's & Colitis Foundation appeal letter library
Customizable appeal letters for Crohn's disease and ulcerative colitis treatments, tests and dose changes, including a request to use a biologic without first failing other drugs. Written for the doctor's office to edit.
From Crohn's & Colitis Foundation