For Consumers

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

Some health plans are not required to meet state or federal requirements. If you’re appealing a health insurance denial from one of these plans, find important contact information in the tables below.

Medicare plans

Where you can find appeals information for Medicare plans

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)

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 you can find appeals information for non-Medicare plans

Non-Medicare plans

Where to look for appeal information

Apple Health (Medicaid for kids and adults)

Washington State Health Insurance Pool (WSHIP)

Self-funded health plans

  • In your plan's materials

  • Contact your human resource department

Military personnel with TRICARE

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.