Washington

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. Follow the steps below to file a complaint and appeal with your health plan:

• Call the member/customer service phone number for your health plan.
• Tell them you want to file a formal complaint and then explain the problem.
• You can also file your complaint by letter, email, or online through your health plan’s website (see below).
• If you disagree with your health plan’s decision, you have the right to file an appeal.

Below are links to the complaint forms for Washington’s top health plans:

• Aetna
• Bridgespan
• Cigna
• Community Health Plan of Washington
• Coordinated Care
• Group Health Cooperative/Kaiser Permanente
• Kaiser Foundation Health Plan of the Northwest
• LifeWise (a Premera affiliate)
• Molina Healthcare of Washington
• Premera Blue Cross
• Regence Blue Shield
• My plan isn’t listed

 

Medicare Plans

 

STEP TWO – File a Complaint

You have the right to file a complaint with the Washington State Office of the Insurance Commissioner (OIC) if you have a problem getting the services you need, including quality and affordable health care. You do not need to complete your health plan’s appeal process before you file a complaint with the OIC. A complaint can be filed at any time. 

• The Washington State Office of the Insurance Commissioner will review your complaint within 30 days.
• File your complaint here.
• Call the Washington State Office of the Insurance Commissioner helpline: (800) 562-6900.