Complaints may be submitted by email, fax or phone.

Complaint research and resolution process:

1. Pull provider file/ information to determine provider status
2. Determine what action needs to be taken
1. Call provider for re-education or determine if correct benefit was given
2. Call member for re-education
3. Based on the findings of representative, provider is contacted when necessary
4. Contact member to inform member of resolution
5. Enter complaint into complaint tracking program
6. File original complaint along with resolution into provider file
7. Average turn around time is 24-48 hours but may take up to 5 business days
8. Member contacted with resolution
9. New Benefits representative notates the member notes field in Data Base
10. File original complaint along with resolution in network file
11. Average turn around time is 36-48 hours but may take up to 5 business days

A letter will be sent to the member if we have not received the invoice given to them by the provider. The first letter goes out as a reminder after 1 week. After that letter is sent off, we wait an additional 2 weeks to see if we received the member’s invoice. If after the 2 week period we have not received the member’s information we send out a second letter to the member. This letter informs the member that since we have yet to receive their information, unless we hear from them otherwise their issue will be considered closed.

For WA residents:

If a resident of the state of Washington remains dissatisfied after completing the organization's complaint process, the plan member may contact the office of the insurance commissioner at:

Washington Office of the Insurance Commissioner

P.O. Box 40259

Olympia, WA 98504-0259

800-562-6900