Find appeals information for plans not subject to state or federal requirements

Medicare plans Where to look for appeal information
Original Medicare
Medicare Advantage
Medicare Prescription Drug (Part D)
Social Security Administration (SSA) (Some Medicare-related issues are decided by SSA)
  • Go to your local SSA office
  • Call 800-772-1213
  • Go to SSA (www.socialsecurity.gov)

Note: SSA determines Medicare eligibility and effective dates, Medicare late enrollment penalties, Medicare premiums for Extra Help and Part D, Social Security Disability Insurance and Supplemental Security Income.

Non-Medicare Plans Where to look for appeal information
Apple Health (Medicaid for kids and adults)
  • Call 800-562-3022
  • The state merged Medicaid into Apple Health which now serves all ages, kids and adults.
Washington State Health Insurance Pool (WSHIP)
Pre-existing Condition Insurance Plan (PCIP)
Self-funded health plans
  • In your plan's materials
  • Contact your Human Resource Department
Military personnel with TRICARE

Note: This plan is exempt from the federal Employee Retirement Income Security Act (ERISA) law (www.dol.gov)

Uniform Medical Plan (UMP)

This is a health plan offered to Washington state public employees (active and retired) and their dependents. This coverage falls under the jurisdiction of the Washington State Health Care Authority and is subject to Washington state’s Patient Bill of Rights. This means that while it has a plan-specific appeal process, many of the rights available to consumers in state-regulated plans will also be available to consumers with this coverage.

Updated 03/27/2014

See also

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