Consumers

Our Mission

We protect consumers, the public interest and our state’s economy through fair and efficient regulation of the insurance industry. 

We’re a small agency of about 280 employees who oversee the insurance market in Washington state. 

We help you with your insurance issues by:

• Investigating complaints about your insurance company or agent
• Proposing laws and adopting rules when consumer protections are needed
• Making sure companies meet their financial obligations to you
• Educating you about your insurance rights
• Helping you understand and navigate Medicare
• Licensing and monitoring the people and businesses that sell insurance
• Reviewing and approving the insurance policies companies sell 

We oversee the people and companies that sell insurance through: 

• Ensuring companies have enough money to pay claims and follow state and federal law
• Making sure companies and agents and brokers are licensed and in good financial standing
• Reviewing and monitoring the policies companies sell and their behavior in the market
• Monitoring troubled companies and preventing financial harm to policyholders
• Reviewing the benefits companies offer and the prices they charge
• Taking enforcement action against individuals and companies who violate insurance laws and regulations 
• Investigating potential misconduct by the people and companies we regulate

We regulate the insurance market in Washington state by: 

• Analyzing insurance company practices and contracts for compliance 
• Finding and prosecuting criminal organizations and individuals engaged in insurance fraud
• Providing regulatory oversight and guidance, keeping our insurance market healthy

The Legislature directed us to work with the Department of Health and the Health Care Authority to study how to prevent balance billing from ground ambulance services and recommend if these services should be subject to Washington's Balance Billing Protection Act.

Our advisory group on this issue sent its recommendations to the legislature in October 2023. Legislation banning ground ambulance balance billing was enacted in 2024. 

Advisory group and report

• Presentation to the Washington State Senate Health & Long Term Care Committee – October 30, 2023 (PDF 907.37KB)
• Ground Ambulance Advisory Group members (PDF 150.32KB)
• Ground Ambulance Study Workplan (PDF 137.11KB)
• 2023 Ground ambulance balance billing report (PDF 1.05MB)
• Ground ambulance balance billing executive summary (PDF 208.40KB)

Advisory Group meetings

August 10 meeting materials

• August 10 meeting agenda (PDF 200.50KB)

Comments on policy options 

• Northwest Health Law Advocates ground ambulance billing recommendations letter (PDF 775.62KB)
• Washington Ambulance Association ground ambulance balance billing letter (PDF 216.52KB)
• Washington Fire Chiefs ground ambulance balance billing letter (PDF 176.19KB)
• Rhonda Holden ground ambulance balance billing letter (PDF 98.01KB)

July 26 meeting materials

• Northwest project presentation (PDF 221.63KB)
• Provider and carrier survey results presentation (PDF 405.67KB)
• Value and systems science lab presentation on EMS services (PDF 673.57KB)
• Value and systems science lab (VSSL) EMS service and vehicle license applications report (PDF 955.82KB)

June 15 meeting materials

• The No surprises act and state action to address ground ambulance bills presentation (PDF 703.63KB)

May 4 meeting materials

• May 4 meeting agenda
• APCD analysis presentation (PDF 1.60MB)

March 31 meeting materials

• March 31 meeting agenda (PDF 180.94KB)
• Health Care Authority presentation (PDF 639.95KB)
• Office of Insurance Commissioner presentations (PDF 856.40KB)
• Systems Designs West presentation (PDF 388.10KB)
• University of Washington presentation (PDF 470.80KB)

February 27 meeting materials

• February 27 meeting agenda (PDF 163.82KB)
• Washington Ambulance Association presentation (PDF 3.50MB)
• Department of Health presentation (PDF 910.96KB)
• Association of Washington Cities presentation (PDF 817.09KB)
• Association of Washington Health Plans presentation (PDF 121.42KB)
• Washington Fire Chiefs presentation (PDF 145.77KB)

January 20 meeting materials

• Jan. 20 meeting agenda (PDF 182.57KB)
• Ground ambulance balance billing presentation (PDF 498.15KB)

One of the following people will review your appeal and issue an initial order:

• Our presiding officer 
• An administrative law judge from the Office of Administrative Hearings (OAH)  

You can submit an appeal after a PBM denies your reimbursement request or if you disagree with the PBM's decision.

You need to send us your appeal within 30 days of receiving the PBM's decision or within 30 days of the PBM's deadline for responding to the first-tier appeal. 

To file an appeal, you also need to meet all the requirements below:

• You're a small pharmacy with no more than 15 retail locations.
• You filled the prescription in Washington state.
• You filled the prescription for a customer with a fully insured, non-ERISA plan.
• The prescription was for a multiple source drug(s). 
• You completed the reimbursement process through your PBM.
• Within the past 30 days, you received a denial or a reimbursement you disagree with. 
• The person submitting the appeal has the authority to file it under WAC 284-180-505. 

The Small Pharmacy Appeals Program follows these laws and rules:

• RCW 48 is the State Insurance Code. 
• WAC 284 contains rules for the insurance industry.  
• WAC 284-180-505 contains rules for appeals from network pharmacies.
• RCW 34.05 is the State’s Administrative Procedure Act.
• WAC 10-08 contains procedures for administrative hearings.  

You can request a hearing by filing a demand for hearing with our Hearings Unit. You don't need to use our form, but we highly recommend it.

Requirements for your demand

Your demand needs to include a copy of the order or action you're contesting. The Hearings Unit is separate from our internal systems and other divisions, so they can't access this information unless you include it. 

You need to file your demand within 90 days of the order or action. If you don't, you'll waive your right to contest it.

Your demand needs to:

• Be in writing
• Explain how the action or order negatively affects you
• Provide your reason for requesting relief
• Include an email address 
• Be delivered to our Tumwater office by email, mail, hand delivery, or fax

Your attorney or representative can sign and file the demand, but it also needs to include your contact information.  

Ways to file a demand and submit documents

Our Hearings Unit recommends electronically submitting demands, documents, and messages. They'll send all communications by email, including when serving legal orders or papers.    

Online

Contact our Hearings Unit online or email hearingsu@oic.wa.gov. 

Fax

Send faxes to 360-339-7061, Attn: Administrative Hearings Unit.

Mail

Administrative Hearings 
Office of the Insurance Commissioner 
P.O. Box 40255                  
Olympia, WA 98504-0255 

After you file a demand 

Our Hearings Unit will review your demand. If it's incomplete, they'll email you to ask for more information. If it's complete, they'll email you to confirm they received it and explain the next steps for your case.

If you file a demand before our action or order goes into effect, it won't go into effect until there's a final decision for your case.

Cases we don't handle

We don't hear cases about unemployment insurance or industrial insurance claims (also known as workers’ compensation). In Washington state, the Employment Security Department handles unemployment benefits, and the Washington State Department of Labor & Industries handles workers’ compensation claims. Contact these agencies if you have questions about these types of claims.