Existing health insurance frequently asked questions

I have a managed-care plan. My primary-care doctor won’t refer me to the specialist I need to see. What are my rights?

You can file a grievance. Your benefits book should describe your plan’s grievance procedure. All managed-care plans must have a grievance procedure for disputes involving service denial and for dissatisfaction with care. You also have a right to go outside the plan to receive services on a self-pay basis.

Is a participating provider in a managed-care plan allowed to charge me amounts greater than the insurer will allow?

No. According to state laws and regulations, participating provider agreements do not allow providers to collect any amount other than what they contractually agreed upon with the health insurance plan (RCW 48.80.030(5), WAC 284-43-320) (www.leg.wa.gov).

The hospital is demanding I pay its entire bill right away. What are my rights?

The Federal Trade Commission (FTC) protects your rights as a debtor under federal law. For more information, call them at 877-FTC-HELP (877-382-4357) or visit the FTC website (www.ftc.gov).

I believe my health care professional provided incompetent services. Who can I call for help?

To complain about a health professional or hospital, call the Washington State Department of Health (DOH) at 360-236-4700, or visit their website (www.doh.wa.gov).

Updated 03/27/2014

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