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Consumer Advocacy

Call: 800-562-6900 (8:30 a.m. to 4:30 p.m., Monday - Friday)
Form: Ask an insurance expert

 

Quick tip

You should file an appeal if you disagree with your insurance company's coverage or payment decision.

You should file a complaint if you think an insurer or agent has violated the law or treated you or your claim unfairly.

Appealing a health insurance denial

When your health insurer says no to a treatment or a bill dispute, that doesn't have to be the final word. You have the right to appeal the decision.

Appealing a behavioral health treatment or service denial

If your health plan refuses to cover a service for mental health or substance use disorders, you can appeal the denial.

Appealing a Medicare coverage or payment decision

You have the right to appeal Medicare's decisions on coverage and payments. Learn where to find information about appeals and how to contact us if you need help understanding the process.

Small pharmacy reimbursement appeals

A small pharmacy located in Washington state can submit an appeal to our office  to review a Pharmacy Benefit Manager's (PBM) decision regarding the reimbursement of a drug's cost.

Related topics

Complaints

You have the right to file a complaint against an insurer or agent. We're here to help you understand the process and what to expect.

Fraud

Insurance fraud costs the average Washington family $400-$700 a year in increased premiums. Learn how we combat fraud and how to file a fraud report.