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Over the next several months, we will be moving the content of this database to the UMP website. This change will allow you to access all UMP benefits information in one place. As content is moved, we will link to the information's new location.

  • 1. How do I submit an appeal or complaint regarding medical services or prescription drugs?
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    As part of our effort to make UMP benefits information easier to find, this item has been moved to the UMP website . You can now find it, and related information, here: Complaints and appeals procedures . This change allows you to access all UMP benefits information in one place.
  • 2. How can I appeal decisions about eligibility for coverage under UMP?
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    %%pebb_elig%% Appeals related to eligibility and enrollment are handled by the Public Employees Benefits Board (PEBB) Program and governed by Washington Administrative Code (WAC) chapter 182-16 . Information on how to file an appeal is available: On the PEBB Appeals webpage . By contacting the PEBB Appeals Manager at 1-800-351-6827 or by email at pebappeals@hca.wa.gov
  • 3. What is an expedited appeal? Updated
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    As part of our effort to make UMP benefits information easier to find, this item has been moved to the UMP website . You can now find it, and related information, here: Complaints and appeals procedures . This change allows you to access all UMP benefits information in one place.
  • 4. If I disagree with what UMP covers, what should I do?
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    As part of our effort to make UMP benefits information easier to find, this item has been moved to the UMP website . You can now find it, and related information, here: Complaints and appeals . This change allows you to access all UMP benefits information in one place.
  • 5. How does the independent review process work?
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    External Review: Independent Review What Is An Independent Review Organization? An Independent Review Organization (IRO) will conduct the external review (also called an “independent review”). An IRO is a group of medical and benefit experts certified by the Washington State Department of Health and not related to the plan, Regence BlueShield, Washington State Rx Services, or the Health Care Authority. An IRO is intended to provide unbiased, independent clinical and benefit expertise  More...
  • 6. How long does the plan have to decide my appeal? Updated
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    As part of our effort to make UMP benefits information easier to find, this item has been moved to the UMP website . You can now find it, and related information, here: Complaints and appeals procedures . This change allows you to access all UMP benefits information in one place.
  • 7. How to Designate an Authorized Representative
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    TIP: Because of privacy laws, the plan usually cannot share information on appeals or complaints with family members or other persons unless the patient is a minor, or the plan has received written authorization to release personal health information to the other person. To authorize someone to receive your protected health information, request an Authorization to Disclose Protected Health Information form (see below). This form must be returned to the address on the form before the plan can sha  More...
  • 8. When You Don’t Have Access to a Preferred Provider: Network Waiver (UMP Classic and UMP CDHP)
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    ALERT! When requesting a network waiver after services are processed, you must submit your request within 180 days of receiving notice of payment (your Explanation of Benefits ) for the related services. See “After Services Are Provided” below for details. What Is a Network Waiver? An approved network waiver allows the plan to pay for services provided by an out-of-network provider at the network rate. You may request a network waiver only when you do not have access to a preferred p  More...
  • 9. Is my issue an appeal or a complaint?
    Preview
    As part of our effort to make UMP benefits information easier to find, this item has been moved to the UMP website . You can now find it, and related information, here: Complaints and appeals procedures . This change allows you to access all UMP benefits information in one place.
  • 10. Can I email the plan about my complaint or appeal?
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    As part of our effort to make UMP benefits information easier to find, this item has been moved to the UMP website . You can now find it, and related information, here: Complaints and appeals procedures (scroll down to the Why can't I email the plan? box). This change allows you to access all UMP benefits information in one place.

The certificate of coverage (COC) for the member's plan is the source of coverage provisions offered under the plans. If information given here is inconsistent with the applicable COC, the rules in the applicable COC will apply. Also, the COC may have additional information on this subject.

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