We're always available to help you better understand your insurance policy, your rights and other places you can go for help. We may not regulate all aspects of your concerns. Please contact us if you're unsure how we can help you. We'll walk you through it.
Our complaint process can help if you've been treated unfairly or unlawfully by an insurance company. If a company isn't responding, for example, we can help you communicate with them. We can review insurance policies issued or insurance business conducted in our state. Knowing the limits of the complaint process is important.
| What we can do with your complaint | What we can't do with your complaint |
|---|---|
| We can send your complaint to an insurance company and require an explanation | We can't establish the facts of a claim, determine values or fault, cause of loss or the amount you should be paid for a claim |
| We can contact your health insurance company and require an explanation if it denied a treatment | We can’t make medical judgments or determine if a treatment is necessary |
| We can review a company's response to your complaint and make sure it followed the law and the policy | We can't act as your lawyer, give you legal advice, act as your claims adjuster or make liability decisions |
| We can request that a company fix a problem if they didn't follow the law and the policy | We can't make a company reinstate or reissue a policy, pay a claim or refund a premium if they followed the law and the policy |
| We can send your complaint to the Washington Healthplanfinder and ask them to review your concerns | We can't require the Washington Healthplanfinder to comply with state insurance laws because they are not an insurance company or regulated by us |
| We can recommend other agencies or organizations that may be able to help with your complaint | We can't address issues we can't legally enforce |
| We can send your surprise or balance billing complaint to medical providers and facilities in Washington | We can't make medical providers and facilities adjust what they charge, respond to your complaint or comply with state insurance laws |