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Knowing Your Rights Regarding Washington Health Insurance Coverage

Getting help

As a health insurance consumer, you should understand what your rights are and how to exercise them.

Patient Bill of Rights

The Washington State Legislature passed the Patient Bill of Rights in 2000. This ensures that patients covered by health plans receive quality care, timely access to health care, and an adequate choice of health care providers. It outlines procedures to ensure patients:

• Make health care decisions based on appropriate medical standards.
• Have better access to information about their health insurance plans.
• Have the right to a second opinion.
• Have access to a quick and impartial process for appealing denials of coverage.
• Have the right to independent third-party reviews of denials.
• Are protected from unneeded invasions of their privacy.
• Can ask for damages that result when managed care insurers withhold or deny appropriate care.

This law took effect July 1, 2001, or on the date of the insurance policy's renewal. For more information, see the Patient Bill of Rights fact sheet at www.insurance.wa.gov or call our Insurance Consumer Hotline at 1-800-562-6900 to request a copy.

Other rights

Employer plans: If your plan is a "self-funded" plan offered by an employer, or by a union trust under a union contract, the federal government regulates your plan. You may file a complaint with the U.S. Department of Labor (DOL) Employee Benefits Security Administration toll free at 1-866-444-3272. DOL may investigate your complaint. In some disputes, DOL may suggest personal legal advice as your best option.

Government/church plans: If the plan is self-funded, but offered through a government or church employer, follow the appeals procedures outlined in your benefit booklet and other plan documents. In most cases, final responsibility for resolving these disputes rests with the governing body of the employer sponsoring the plan, such as a school board.

The disabled: If you have a disability, you may have special protections available under the Americans with Disabilities Act (ADA) that apply specifically to self-funded coverage. You can reach the ADA Technical Assistance Center at 1-800-949-4232 or the U.S. Department of Justice at 1-800-514-0301 (voice) or 1-800-514-0383 (TDD).