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Consumer Advocacy

Call: 800-562-6900 (8:30 a.m. to 4:30 p.m., Monday - Friday)
Form: Ask an insurance expert

 

Quick tip

You should file an appeal if you disagree with your insurance company's coverage or payment decision.

You should file a complaint if you think an insurer or agent has violated the law or treated you or your claim unfairly.

How to appeal a health insurance denial

If your health insurer won't pay for a treatment or a bill, you have options.

Common reasons for a denial and examples of appeal letters

Some treatments, such as experimental ones, are often denied by insurers. Learn about more common denials and find appeal letter templates you can use

Identify your type of insurance coverage

It's important to understand out who regulates your health plan so you know your rights and which laws your plan's appeal process follows.

Appealing a Medicare coverage or payment decision

You have the right to appeal Medicare's decisions on coverage and payments. Learn where to find information about appeals and how to contact us if you need help understanding the process.

Appeals information for Medicare and plans we don't regulate

Find who to contact if you're appealing a decision from Medicare or another type of plan not subject to certain state and federal requirements.

Appealing a behavioral health treatment or service denial

If your health plan refuses to cover a service for mental health or substance use disorders, you can appeal the denial.

Small pharmacy reimbursement appeals

A small pharmacy located in Washington state can submit an appeal to our office  to review a Pharmacy Benefit Manager's (PBM) decision regarding the reimbursement of a drug's cost.

Related topics

Complaints

You have the right to file a complaint against an insurer or agent. We're here to help you understand the process and what to expect.

Fraud

Insurance fraud costs Washington families about $3,700 more each year in higher premiums. Learn how we fight fraud and how you can report it.