Appeals information for Medicare and other plans not subject to Office of the Insurance Commissioner regulations

Original Medicare

• On the back of your Medicare Summary Notice (www.medicare.gov)

• Medicare claims and appeals (www.medicare.gov)

• Your Medicare rights (www.medicare.gov)

• The current version of Medicare & You (PDF, 4.09MB) (www.medicare.gov)

Medicare Advantage

• In your plan's materials

• Call your plan

• Your Medicare rights (www.medicare.gov)

• The current version of Medicare & You (PDF, 4.09MB) (www.medicare.gov)

Medicare Prescription Drug (Part D)

• In your plan's materials

• Call your plan

• Your Medicare rights (www.medicare.gov)

• The current version of Medicare & You (PDF, 4.09MB) (www.medicare.gov)

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.

Apple Health (Medicaid for kids and adults)

• Call 800-562-3022

• The state merged Medicaid into Apple Health (www.hca.wa.gov), which now serves all ages, kids and adults.

Washington State Health Insurance Pool (WSHIP)

• Call 800-877-5187

• Go to WSHIP (www.wship.org)

Self-funded health plans

• In your plan's materials

• Contact your human resource department

Military personnel with TRICARE

• Call the appropriate TRICARE contact number (www.tricare.mil) for your area

• Go to the TRICARE appeals process (www.tricare.mil)

Uniform Medical Plan (UMP)

• Call 888-849-3681

• Go to Complaint and Appeal Procedures (www.ump.hca.wa.gov)

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.