Washington Parity Resources

For general information about filing a parity appeal for mental health or addictions services, you cannot go wrong with contacting one of the consumer advocates below. Each has years of experience helping consumers in the state of Washington. Office of the Insurance Commissioner https://www.insurance.wa.gov/your-insurance/health-insurance/ Washington Autism Alliance & Advocacy 16225 NE 87th St. Suite A-2 Redmond, WA 98052 Key contact: Mira Posner Redmond Offices Phone: 425.894.7231 Spokane Office Phone: 509-598-3413 Yakima Office Contact: Erin Deery Email: Erin@WashingtonAutismAdvocacy.org Vancouver Office Phone: 360-514-8365

When filing an appeal for the first time, you should contact your health plan’s customer service support line or check out their information online. If you choose to appeal an adverse benefit determination concerning your mental health or substance use treatment or benefits, please keep in mind that the timeframe to do so varies by state, plan type, and other factors. Contact your state’s department of insurance for additional information. Here is some contact information for Washington Health Plans:

Asuris Northwest Health

Appeals can be initiated through either written or verbal request. To initiate an appeal, consult the benefit booklet, or call or write. Information regarding Appeals

Bridge Span Health

Call Member Services: 855-857-9944 Written appeals send to: BridgeSpan Health PO Box4208 Portland, OR 97208-4208

Community Health Plan

Call Customer Service: 800-440-1561 To file a grievance by mail send to: Community Health Plan of Washington Attention: Customer Service 720 Olive Way, Suite 300 Seattle, WA 98101

Coordinated Care

Call Member Services: 877-644-4613 Member Grievance Form found here or write a letter and send to: Grievance Department 1145 Broadway, Suite 300 Tacoma, WA 98402

Kaiser Permanente

Call Membership Services To file an appeal: form found here Kaiser Foundation Health Plan of Washington Member Appeals PO Box 34593 Seattle, WA 98124-1593

LifeWise Health Plan of Washington

Call Customer Service: 800-592-6804 Written requests send to: LifeWise Health Plan of Washington PO Box 91059 Seattle, WA 98111-9159

Molina Healthcare

Call Member Services: 800-869-7165 Send written grievance to: Molina Healthcare Attention: Member Appeals PO Box 4004 Bothell, WA 98041-4004 Email: wamemberservices@molinahealthcare.com

Premera Blue Cross

Call Customer Service: 800-722-1471 To file an appeal: form found here Mail form to: Premera Blue Cross Member Appeals Department PO Box 91102 Seattle, WA 98111-9202

Regence Blue Shield

Call Member Services: 800-365-3155 Appeal form found here Mail forms to: Regence BlueCross BlueShield of Oregon Attn: Regence Level 1 Member Appeals PO Box 4208 Portland, OR 97208-4208

United Healthcare

Call Member Services at the number on the member ID card  

Insurance Commissioner

Washington State Office of the Insurance Commissioner Commissioner Mailing: P.O. Box 40256 Olympia, Washington 98504-0256 Physical: 500 Capitol Boulevard, SE Tumwater, Washington 98501 Toll Free: (800) 562-6900 Phone: (360) 725-7000 Fax: (360) 586-3535

Utilization Management Appeals

Washington State Office of the Insurance Commissioner Commissioner Mailing: P.O. Box 40256 Olympia, Washington 98504-0256 Physical: 500 Capitol Boulevard, SE Tumwater, Washington 98501 Toll Free: (800) 562-6900 Phone: (360) 725-7000 Fax: (360) 586-3535

External Review Appeals

Washington State Department of Health Policy Coordinator Mailing: P.O. Box 40256 Olympia, Washington 98504-0256 Physical: 500 Capitol Boulevard, SE Tumwater, Washington 98501 Phone: (360) 236-4612 iro@doh.wa.gov

Parity Appeals

Washington State Office of the Insurance Commissioner Commissioner Mailing: P.O. Box 40256 Olympia, Washington 98504-0256 Physical: 500 Capitol Boulevard, SE Tumwater, Washington 98501 Toll Free: (800) 562-6900 Phone: (360) 725-7000 Fax: (360) 586-3535 Additional Washington Insurance Administration Contacts, click here

The federal government also can be a helpful resource if you are enrolled in a self-funded plan, Medicare, Medicaid or another type of insurance that is overseen at least in part by a federal agency.

For definitions and filing information refer to the Parity Resource Guide

U.S. Department of Health and Human Service’s website on the Affordable Care Act health reform law

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA)

(SAMHSA) Implementation Mental Health Parity Addiction Equity Act

U.S. Centers for Medicare and Medicaid Services (CMS)

U.S. Department of Labor, Employee Benefits, Security Administration (EBSA) or toll-free hotline: 1.866.444.EBSA (3272)

For the U.S. Department of Health and Human Services & Centers for Medicare and Medicaid Services list of exempt state and local plans, please email NonFed@cms.hhs.gov. You may ask them if any particular state and local plan has opted out of MHPAEA.

Information on requirements of employer-based insurance coverage and self-insured health plans.
EBSA has benefit advisors who are available to answer questions and provide assistance in obtaining your benefits.

Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits

Veterans and military personnel can use these resources to get help or more information with their medical or behavioral health complaints.

Health Net Federal Services

A grievance is a written complaint or concern about a medical provider.
Click here for specific information regarding who, what and how to file.

TRICARE

View the recently released Tricare Mental Health Fact Sheet.

The appeal process is different based on the benefit issue. Depending on your issue, you can file a:

• Factual appeal
  • This is if you were denied payment for services or supplies you received, or if payment was stopped for services or supplies previously authorized.
• Medical necessity appeal
  • This is if prior authorization for care or services was denied because it was not deemed medically necessary. Medically necessary means it must be appropriate, reasonable, and adequate for your condition.
• Pharmacy appeal
  • This is if you don’t agree with a decision made about your pharmacy benefit. For example, Express Scripts denies your pharmacy claim.
• Medicare-TRICARE appeal
  • This is if you’re eligible for both TRICARE and Medicare, and Medicare denies your services or supplies.

If your care is denied, you should receive a letter with details about how to file your appeal.

Veterans Health Administration

Complaints are initially handled through the Patient Advocate.
Patient Advocate can be contacted at your local VA Medical Center.

If you have any additional questions about parity compliance, please contact info@paritytrack.org