Health insurance policyholders are guaranteed specific rights under Washington State’s Patient Bill of Rights. The law’s purpose is to guarantee health insurance policyholders have access to quality health care. If you find yourself in a dispute with your health insurance carrier, knowing these rights may help.
Policyholders Have The Right To Know About Their Coverage. Health insurers must provide prospective policyholders specific information before the policyholder purchases coverage. This include:
- A list of doctors, hospitals and other providers who participate in the insurance plan.
- An explanation of the policyholder’s premiums and charges;
- How the policyholder can fight a wrongful claim denial, including through filing grievances;
- Coverage information, including information about what prescription drugs are covered;
- Explanations of any exclusions or limitations that apply to your coverage;
- Information about the insurer’s efforts to protect policyholders’ confidential information;
- Any applicable copayment, delectable, and/or coinsurance charges.
Policyholders Have The Right To Access Medical Treatment. Health insurers must allow policyholders to choose their own Primary Care Provider, although the insurer is permitted to require the policyholder to choose from a specific list. The insurer must also allow policyholders to change providers if necessary. Insurers must also maintain adequate networks containing every category of licensed medical providers. If needed to treat the policyholder’s condition, the insurer must provide referrals to specialists. Finally, health coverage must include women’s health care.
Policyholders Have The Right To Challenge Claim Denials. Health insurers must respond to complaints about wrongful coverage denials through a formal grievance process that is prompt, fair and impartial.
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