Questions, requests, complaints, and disputes, including how to appeal an Eligibility Decision

If you have a question, request, complaint, or dispute about something related to your Washington Healthplanfinder application or eligibility, you can use this page to help you decide how best to resolve your issue. We want to help resolve your problem as quickly as we can. 

IMPORTANT: Before you go further, is your issue regarding Washington Apple Health (Medicaid)? If so, you’ll want to contact the Health Care Authority (HCA). They administer the Washington Apple Health program and can help you with your questions your eligibility and coverage. 

Washington Apple Health: 1-800-562-3022
Washington Apple Health Email: [email protected]
OnlineSecure web form
Assistance in your local area: HCA community-based specialists

Washington Healthplanfinder Questions and Requests

If you have a question, need help making an update or a correction, or have a request involving your Washington Healthplanfinder application or account, contact the Customer Support Center at 1-855-923-4633 or use the Washington Healthplanfinder chat function. This is the first step in resolving any questions, errors, or issues with your Washington Healthplanfinder account, application, or enrollment. Customer Support representatives can answer your questions, assist with updating your application, correcting mistakes, or submitting a ticket for review of your request. 

If you have a question about the status of your Washington Healthplanfinder application or about documents that are being requested, for example, our Customer Support Center can help you. 

If you want your health insurance coverage to start earlier than shown on your Washington Healthplanfinder account, or if you made a mistake and need help correcting it, our Customer Support Center can help you. 

Customer Support can also answer general questions about completing your application, explain your eligibility, or submit a ticket to escalate a complex problem or report a technical error.

Complaints

The Exchange is committed to resolving customer concerns. If you are dissatisfied with Washington Healthplanfinder or with the assistance you received from the Customer Support Center, you may file a complaint using our online Complaint Form

IMPORTANT: If you have a complaint about your health insurance or dental carrier or about billing, your benefits, coverage, or a claim, please contact your carrier directly. You can also contact the Office of the Insurance Commissioner to file a complaint about your health care or dental care benefits, coverage, or carrier.

Disputes or Appeals

The Exchange is committed to resolving customer concerns. If you believe your Washington Healthplanfinder eligibility is wrong, you have the right to file an appeal.

An appeal is a legal proceeding. By submitting an appeal request, you believe an eligibility decision is wrong and you want a Presiding Officer (judge) to review it. They have the authority to review Washington Healthplanfinder eligibility decisions only and cannot rule on enrollment issues or decisions made by any entity other than Washington Healthplanfinder

Appeals must be filed within 90 days of the eligibility results. An appeal received more than 90 days after the date on the eligibility results is not a valid appeal. Learn the steps to file an appeal below.

Once you’ve filed a request for an appeal, the process ends only when the judge issues a decision. The judge will dismiss your appeal if you withdraw it or if you don’t call in for your prehearing conference or hearing. 

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 or 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

IMPORTANT: If your appeal is not for one of the reasons above, or if your eligibility results letter is more than 90 days old, your appeal may not be valid or may not be something the judge can decide. The judge does not have the authority to rule on an invalid appeal or on any matter other than an eligibility decision.

Do you need help deciding what option is best for your situation?

  • I want to sign up for health insurance, but I was denied
    • I applied for health insurance and was told that I do not qualify for a Special Enrollment Period (SEP)
      • Please review the qualifying life events that enable a special enrollment period.
      • Call Customer Support, 1-855-923-4633, to make sure you’ve submitted your ‘qualifying life event’ correctly. Ask the representative to submit a ticket for review of your Special Enrollment Period eligibility, if needed.
      • Appeal if you believe Washington Healthplanfinder is wrongly denying your Special Enrollment Period.
    • I think Washington Healthplanfinder made an error and I want to explain why
      • Call Customer Support, 1-855-923-4633, to review your account information and request a review of your eligibility
      • File a complaint. We’ll do some research, check your eligibility, and get back to you as quickly as we can.
      • File an appeal. Review your Washington Healthplanfinder account to make sure it contains accurate information, and if you still believe your eligibility is wrong, you may appeal.

  • I already paid for a plan but I have a problem with my application
    • I made a change on my Washington Healthplanfinder application and I disagree with my new tax credit amount
      • Call Customer Support, 1-855-923-4633, to review your account information and request a review of your eligibility.
      • File a complaint. You’re dissatisfied with your tax credit amount but it was calculated correctly. We will do some research and get back to you as quickly as we can.
      • File an appeal. Review your Washington Healthplanfinder account to make sure it contains accurate information, and if you still believe your tax credit amount is wrong, you may appeal.
    • My insurance carrier ended my coverage
      • Contact your insurance carrier directly
    • I think Washington Healthplanfinder made an error and I want to explain why
      • Call Customer Support, 1-855-923-4633, to review your account information and explain your eligibility. You may ask that a ticket be submitted for additional review of your eligibility.
      • File a complaint. We will do some research, check your eligibility, and get back to you as quickly as we can.
      • File an appeal. Review your Washington Healthplanfinder account to make sure it contains accurate information, and if you still believe your eligibility is wrong, you may appeal.

Contact the Health Care Authority regarding your complaint or disagreement. The Health Care Authority determines eligibility for Washington Apple Health and administers the program.

Phone: 1-800-562-3022
Email: [email protected]
OnlineSecure web form
Assistance in your local area: HCA community-based specialists

  • This employee was offered affordable health coverage and declined to enroll
    • Contact the Appeals Program for more information: 1-855-859-512 or [email protected]
    • File an appeal if you can't resolve this dispute with your employee.

  • This employee was not offered affordable health coverage (for any reason, such as not being a full-time employee, being a seasonal employee, or being a contract worker)
    • You do not have a dispute. Disregard the letter.

  • This person is no longer an employee, or this person was never an employee
    • You do not have a dispute. Disregard the letter.

Filing an Employer Appeal

If you’re an employer who recently received notification that one of your employees was found eligible for a tax credit, please see these Frequently Asked Questions: www.wahbexchange.org/new-customers/appeals/appeals-faqs/#employers. If you cannot resolve the dispute with your employee, you can fill out a hearing request form. The hearing will be held with you and the employee and adjudicated by the Presiding Officer.

Filing an Individual Appeal

Washington Healthplanfinder customers have 90 days to appeal an eligibility decisions, from the date on the eligibility results letter. The prehearing conference and hearing will be held by telephone conference call. You have the right to provide documents and include witnesses that support your position. 

The quickest way to ask for a hearing is to fill out an Appeal Request Form:

Contact us:

Email: [email protected]
Phone: 1-855-859-2512 (toll-free)
Mail: Washington Health Benefit Exchange
ATTN: Appeals Program
PO Box 1757
Olympia, WA 98507 

Please provide your full name, date of birth, Washington Healthplanfinder application ID, and a phone number where you can be reached.

Accessibility

The Appeals Program provides comprehensive language translation and interpreter services at no cost to you. This includes telephone interpreter services in at least 150 languages and written translations of notices and decisions in a language that you understand. Please let us know if you need documentation in another format, such as Braille or large print, and/or how we can accommodate your needs. Other accommodations include: a sign language interpreter, extended time for hearings and recesses, and assistive listening and/or seeing devices.

Washington Relay Service

At your request, the Appeals Program can use Washington Relay Service. This is a free service by the Washington State Department of Social and Health Services. It ensures equal communication access to the telephone service for people who are deaf, deaf-blind, hard of hearing, and speech-disabled. 

This service allows the Appeals Program staff to communicate with text-telephone (TTY) users. If you're deaf or hard of hearing and need to contact the Appeals Program, simply dial 711 to connect with a relay operator through the Washington Relay Service. The relay operator will dial the requested number and relay the conversation between the two callers.

Equal Access

Anyone with a disability who needs assistance to participate in an appeal can ask the Appeals Program for assistance. Please email or call the Appeals Program to explain what accommodation you would like. 

You may request any assistance that will help you fully and meaningfully participate in the appeals process, so please request the accommodation that will best allow you to do that. 

The Exchange is also committed to providing services that embrace diversity, respect the rights of all individuals, are open and accessible, and are free of bias or discrimination based on, but not limited to, ethnicity, race, creed, color, religion, age, disability, sex, marital status, national origin, political opinions or affiliations, veteran status, and genetic information. 

Anyone with questions about compliance or a complaint regarding bias, harassment, or discrimination should contact the Exchange Legal Department at: 

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]

U.S. Department of Health and Human Services

The U.S. Department of Health and Human Services appeals entity serves as the second-level review once the Exchange appeals process has been exhausted. If you wish to appeal the Exchange's decision you may file an appeal with the U.S. Department of Health and Human Services.

  • Online

  • By mail or fax. You can open a blank appeal form in your browser, print it, and hand write your answers on the paper form. Filling out the form by hand can allow for errors and incomplete answers. This could delay our response. Please read all instructions carefully before submitting a handwritten form.

HHS Mailing address:

Health Insurance Marketplace
Attn: Appeals
465 Industrial Blvd.
London, KY 40750-0061 

Secure fax line: 1-877-369-0130 

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.

Additional Resources