Appeals

When you apply through Washington Healthplanfinder, you get eligibility results. These results show the coverage and savings programs you qualify for. If you think these results are incorrect, you can file an appeal. An appeal is a legal process where a judge reviews your results.

We encourage you to share questions, complaints or disputes about your application with us. Visit our Support Center before you file an appeal. We want to resolve any issues you come across.

Washington Apple Health (Medicaid) Appeals

If the results you want to appeal are about Apple Health, contact the Washington State Health Care Authority. They manage Apple Health, and they can assist with any issues you have. Their information is below.

 

Washington State Health Care Authority (HCA)

Phone: 1-800-562-3022

Email: [email protected]

Online: Secure web form

Local Assistance: HCA Community-Based Specialists

Washington Healthplanfinder Appeals

Washington Healthplanfinder is committed to resolving any concerns you have. You have the right to file an appeal if you think your eligibility results are incorrect.

 

An Appeal Is a Legal Process

When you file an appeal, you want a judge to review your eligibility results. This judge can only review your eligibility results from Washington Healthplanfinder. They cannot rule on decisions made by any other entity.

The appeal process ends when the judge issues a decision. They will dismiss your appeal if you withdraw it or do not call in for your prehearing conference or hearing.

The prehearing conference and hearing will be conducted over the phone. You can provide documents and witnesses to support your position.

 

Appeal Deadlines

You must file an appeal within 90 days of the date of the result you want to dispute. Any appeal received after this deadline is invalid (void).

Here are common examples of results you may appeal:

  • Eligibility for a Qualified Health Plan
  • Eligibility for a Qualified Dental Plan
  • Eligibility for Cascade Care Savings or the amount you received
  • Eligibility for tax credits or the amount you received
  • Eligibility for cost-sharing reductions or the amount you received
  • Eligibility for special enrollment
  • Eligibility for American Indian and Alaska Native (AI/AN) benefits
  • Eligibility for childcare worker sponsorship

 

Filing an Appeal

Click the button below to fill out an Appeal Request Form.

You can contact us with questions about your appeal by phone, email or mail. Provide your full name, date of birth, application ID and phone number if you do.

Email: [email protected]

Phone: 1-855-859-2512

Mail:

Washington Health Benefit Exchange

ATTN: Appeals Program

PO Box 1757

Olympia, WA 98507

 

Note: Your appeal may be invalid (void) if it is not received by the deadline. Your appeal may be dismissed without a ruling if you appeal something not listed above. A judge cannot rule on appeals received under these circumstances.

 

Second-Level Appeals

If you disagree with the judge’s ruling, you have the right to file a second-level appeal. Instructions to do this are provided when the judge issues your ruling.

Accessibility

Translation Services and Accessible Communications

The Appeals Program provides translation and accessibility services at no cost to you. This includes:

  • Over-the-phone interpreter services in over 200 languages
  • Written translations of notices and decisions
  • Braille or large print documents
  • Sign language interpretation
  • Extended time for hearings
  • Assistive devices

Anyone who needs assistance with the appeal process can ask for it. Let us know what accommodations you need to fully participate in your appeal.

 

Washington Relay Service

The Appeals Program can use Washington Relay Service at your request. This is a free service provided by the Washington State Office of the Deaf and Hard of Hearing. This service seeks to ensure equal access to over-the-phone services.

The Washington Relay Service allows the Appeals Program to communicate with text-telephone (TTY) users. Dial 711 to connect with a relay operator through the Washington Relay Service. The relay operator can connect you with the Appeals Program and relay the conversation between callers.

 

Equal Access

Washington Healthplanfinder commits to providing services that are accessible to everyone. We embrace diversity and respect the rights of all. We do not hold bias or discriminate based on, but not limited to, ethnicity, race, creed, color, religion, age, ability, sex, gender, marital status, nation of origin, political opinion or affiliation, veteran status or genetic information.

If you have questions about compliance or a complaint about bias, harassment or discrimination, contact our Legal Department:

 

Washington Health Benefit Exchange Legal Department

ATTN: Legal Division Equal Access/Equal Opportunity Coordinator

PO Box 1757

Olympia, WA 98507-1757

Phone: 1-844-586-9350

Email: [email protected]

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