The Patient Bill of Rights is a state law (leg.wa.gov) guaranteeing health insurance consumers have access to quality health care.
Your benefit rights
Some health benefits are required by either state or federal law — or both — and must be in all health insurance plans.
Before you even sign up or your employer enrolls you in a plan, the plan must tell you the following:
- What benefits are covered, including prescription drug coverage
- Any exclusions, limitations or reductions in coverage
- How it protects your confidentiality
- Your premiums and other costs
- How to file a grievance or request an independent review of your claim
- The amount you need to pay for services (e.g. copayment, deductible or coinsurance)
- Participating providers and facilities
Your right to access care and providers
- Your health plan must allow you to choose a primary health care provider from a list of participating providers and, if necessary, allow you to change medical providers. It should also allow you access to every type of licensed medical provider.
- The health plan must provide you with prompt and appropriate referrals to specialists. If you have a complex or serious condition, your plan may give you a standing referral to a specialist.
- If your plan covers chiropractic care, it must allow you direct access to a chiropractor.
- The plan must have access to women's health care.
Your appeal rights
Health plans must have a grievance process that allows you to appeal any claim denial. The process must be prompt, fair and impartial. To find out more about the appeals process, check out our appeals guide.
Health insurance companies and your providers cannot disclose your personal information, including your health records, unless you give them written permission to do so.