Appeal 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 about eligibility and enrollment.
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, for example, 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.
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 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 still 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. If you want to file an appeal, click here.
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.
These are examples of eligibility results:
- Eligibility for a Washington Healthplanfinder Qualified Health Plan,
- Eligibility for Advance Premium Tax Credits, or the amount of tax credit you’re eligible for,
- Eligibility for lower out-of-pocket costs, or the amount of cost-sharing you’re eligible for,
- Eligibility for a Special Enrollment Period,
- Eligibility for benefits as an enrolled American Indian/Alaska Native
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. The judge does not have the authority to rule on an invalid appeal.
If your dispute is not appealable, you may choose to contact Customer Support, submit a ticket for review of your Washington Healthplanfinder account and reason for your dispute, and/or file a complaint. If you file a complaint, we’ll do some research, check your eligibility, and get back to you as quickly as we can.
Do you need help deciding what option is best for your situation?
If you’re an employer who recently received notification that one of your employees was found eligible for a tax credit, 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, 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:
- អក្សរខ្មែរ – Cambodian (Khmer)
- 中文 – Chinese (simplified)
- 한국어 – Korean
- ພາສາລາວ – Lao
- Pусский – Russian
- Af-soomaali – Somali
- Español – Spanish
- Tiếng Việt – Vietnamese
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.
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 Office of the Deaf and Hard of Hearing. 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.
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
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.
- By mail or fax. You can open a blank appeal form in your browser, print it, and handwrite 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
465 Industrial Blvd.
London, KY 40750-0061
Secure fax line: 1-877-369-0130
- Appeals Process FAQs
- Appeals Administrative Hearing Rights and Deadlines
- Procedural Rules for Appeals
- Affordable Care Act Federal Regulations