My rights to see a medical provider (Every Category law)

Most health plans in Washington state, by law, must include access to every type (also called "every category") of licensed medical provider.

What the "Every Category" law means for you

  • Health plans must maintain adequate networks containing every category of licensed medical providers.
  • You have more choice in who will treat your condition.
  • The law (apps.leg.wa.gov) does not change what conditions are covered by your health plan.
  • Health plans can limit the number of times you can see a provider for certain conditions.
  • Managed care plans may require a "gatekeeper" (e.g. your primary care doctor) visit before they'll refer you to another provider.

Medical providers covered by this law

All medical providers, such as licensed massage therapists and chiropractors, who are licensed, registered or certified by the Washington State Department of Health (www.doh.wa.gov).

Health plans not covered by this law

  • Self-funded employer plans or union trusts
  • Medicare Supplement plans
  • Long-term care insurance
  • Limited health plans - such as dental, vision, specific disease, or accident-only
  • Workers’ compensation coverage
  • Disability income
  • Short-term health plans, such as college-student health plans

Updated 03/27/2014

See also

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