What we can do:
- Send your surprise/balance billing concerns to Washington state providers/facilities.
- Send your complaint to the insurance company and require them to provide an explanation for their actions.
- Send your complaint to the Washington Healthplanfinder and ask them to resolve your concerns.
- Review the company’s response to make sure they followed Washington state laws and your policy.
- Tell the company to fix the problem if they didn’t follow the laws or your policy.
- Try to find patterns of problems that may need further reviewing.
- Try to help fix your insurance problem or help you and the company communicate with one another.
- Help you understand your insurance policy.
- Recommend places you can go for help if we don’t have the legal right to resolve your complaint.
What we can’t do:
- Require medical providers/facilities to adjust their charges, respond to complaints, or comply with state insurance laws.
- Act as your lawyer, give you legal advice or be your claims adjuster.
- Make medical judgments or determine if further treatment is necessary.
- Make liability decisions or determine who is at fault.
- Establish the facts surrounding a claim (for example: who is being truthful when there are conflicting reports of the situation).
- Determine the cause of loss, value of a claim, the amount owed to you, or act as your adjuster.
- Address issues we can’t legally enforce.
- Require the Washington Healthplanfinder to comply with state insurance laws as it's not an insurance company regulated by our office.
- Tell a company to pay a claim, refund a premium, or reinstate or issue a policy (if they followed the law and your policy).