Grievances and appeals in WA

You or your approved representative can file a grievance or appeal at any time.

Let us know if we missed the mark

You may want to file a grievance if:

You're not satisfied with Wellpoint for any reason.

You've had a problem with the quality of care you’ve received from our services or network providers.

You've had difficulty getting access to care.

You feel your rights and dignity have been disrespected.

You have experienced rude behavior from a provider or a Wellpoint associate.

To appoint a representative to act on your behalf, please provide your written consent. Your representative can be a friend or family member, your doctor, or an attorney.

To file a grievance, either:

Call us at 833-731-2167 (TTY 711) or

Write to us at:

Wellpoint Washington
Attn: Grievances
705 5th Ave S., Suite 300
Seattle, WA 98104

Please include the date the problem happened, who was involved, and as much information about the event as you can.

Our grievance coordinator will then:

Call or send you a letter within 2 business days to confirm we received your complaint.

Look into your grievance and address your concerns within 45 calendar days.

If we can't resolve your complaint, you can also file a grievance with the Health Care Authority by calling 800-562-3022 (TTY 711).

You can appeal if your service gets denied

If we deny, reduce, or end treatment or services, we’ll send you a Notice of Adverse Determination. It will:

Explain why we won't pay for the care or services your provider asked for.

Tell you about your right to appeal our decision.

You or your approved representative can appeal the decision.

Have questions?

Check your member handbook or live chat with a representative in the Sydney Health app.

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