When you apply for health and dental insurance through Washington Healthplanfinder™, you get eligibility results. These results show the coverage and savings programs you qualify for. If you believe your eligibility results are incorrect, you have the right to appeal. An appeal is a legal process where a judge reviews your results.
We are here to help. If you have a question, request, complaint, or dispute about your application, please contact our Customer Support Center at 1-855-923-4633, or reach out to one of our trusted resources in your community.
If our customer support network has not resolved a problem, and you would like to file a complaint, you can submit a complaint form here.
If you want to appeal an Apple Health decision, contact the Washington State Health Care Authority. They manage Apple Health, and they can help you with your questions, eligibility, and coverage.
Washington State Health Care Authority (HCA)
Phone: 1-800-562-3022
Email: [email protected]
Online: Secure web form
Local Assistance: HCA Community-Based Specialists
If you have a complaint or need help with your health or dental benefits or coverage, please contact your insurance company directly. You can find their contact information on your insurance card.
You can also contact the Office of the Insurance Commissioner to file a complaint about your health care benefits, coverage, or insurance company.
When you file an appeal, you are requesting 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, including Apple Health, or a decision made by an insurance carrier.
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.
Here are common examples of results you may appeal:
You must request an appeal within 90 days of the date of the eligibility decision you want to dispute. An appeal received after this deadline is not valid.
To submit an appeal, fill out the Appeal Request Form (PDF). You can submit the form through email, fax, or mail.
You can also submit an appeal through:
Email: [email protected]
Phone: 1-855-859-2512
Mail:
Washington Health Benefit Exchange
ATTN: Appeals Program
PO Box 1757
Olympia, WA 98507
Fax: 360-841-7653
Online: Submit an appeal request online.
In-person:
Washington Health Benefit Exchange
810 Jefferson Street SE
Olympia, WA 98501
You can contact us directly with questions about your appeal by phone, email, or mail. When you contact us, provide your full name, application ID and phone number.
Email: [email protected]
Phone: 1-855-859-2512
Most appeals follow these steps:
You can request an expedited hearing. If you want an expedited hearing, you must request it and you will need to explain or provide documents to support your request. Your explanation or documents should show that you have an immediate need for health services because the regular appeal process could jeopardize your life, health, or ability to attain, maintain, or regain maximum function.
The judge will decide whether to grant your request for an expedited hearing based on the explanation or documents you submit. If the judge grants your request for an expedited appeal, your appeal will be scheduled for a hearing immediately and the judge will issue a decision within 14 calendar days.
You must file an appeal within 90 days of the date of the result you want to dispute. An appeal received after this deadline is not valid, and no hearing will be scheduled.
Federal rules give you 90 days from the date on the eligibility results in dispute to request an appeal. You may submit written good cause explanation for failure to submit an appeal within 90 days of the eligibility determination if the delay was due to exceptional circumstances.
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.
You may hire a person, such as a lawyer or an organization to act on your behalf. This is not required and most people represent themselves. The Exchange will not pay for an attorney if you choose to hire one.
The Northwest Justice Project is a nonprofit statewide organization that provides free civil legal services to low-income people from 17 offices throughout Washington state. Each year, the Northwest Justice Project assists more than 18,000 people in need of critical legal assistance.
Address: 401 Second Ave. S, Suite 407, Seattle, WA 98104
Phone for King County: 206-464-1519 or 1-888-201-1012
Phone for all other counties: 1-888-201-1014 or 1-888-201-1021 (Spanish-only speaking clients)
Washington Law Help is a website guide to free civil legal services for low-income persons and seniors in Washington. The website provides legal education materials and tools that give basic information on a number of legal problems. It provides information on free legal aid programs in Washington and their contact information.
The Appeals Program provides translation and accessibility services at no cost to you. This includes:
Anyone who needs assistance with the appeal process can ask for it. Email or call the Appeals Program to let us know what accommodations you need to fully participate in your appeal.
The Appeals Program can use Washington Relay Service at your request. This is a free service provided by 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.
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]
