For Consumers

What you can do when your health insurer says no

Contact Public Affairs: 360-725-7055

March 1, 2013

OLYMPIA, Wash. - Little-known fact: When your health insurer denies a treatment or won’t cover a bill, that’s not necessarily the final answer. In most cases, you can appeal that decision.

 

“Too many people, not knowing they have the right to appeal, end up settling for the answer `No,’” said state Insurance Commissioner Mike Kreidler. “If you’re not getting a critical treatment or the company is rejecting bills, you should definitely consider filing an appeal. It takes some work, but consumers often win.”

 

Even if the insurer says no, consumers can often appeal to an independent group with the power to overrule the company. Nearly a quarter of Washingtonians who do that end up winning.

 

Kreidler’s office has posted an easy-to-use guide to filing appeals on its website at www.insurance.wa.gov/appealing-health-insurance-denial

 

The guide has been recently overhauled to make it easier to use. It includes step-by-step tips, examples, and downloadable letters that consumers can fill out and send to their insurer.

 

The insurance commissioner’s office also has experts on staff who can help consumers with their appeal. They can be reached at 1-800-562-6900 or you can email us.