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  • 1. How do I submit an appeal or complaint regarding medical services or prescription drugs?
    The following provides a brief overview of how you can appeal or complain to the plan. You can start with calling one of the phone numbers below. Many issues can be resolved this way. Customer Service for issues involving prescription drugs Washington State Rx Services 1-888-361-1611 Customer Service for issues not involving prescription drugs Uniform Medical Plan 1-888-849-3681 If you are not satisfied with the outcome of your phone call (you do not have to call before sending in a written appe  More...
  • 2. How can I appeal issues relating to eligibility for coverage under UMP Classic and UMP CDHP?
    Appeals related to eligibility and enrollment are handled by the Public Employees Benefits Board (PEBB) Program and governed by WAC chapter 182-16 . Information on how to file an appeal is available: On the PEBB website . By contacting the PEBB Appeals Manager at 1-800-351-6827 or by email at pebappeals@hca.wa.gov
  • 3. Forms available online: medical claim form, prescription drug forms, and some eligibility forms.
    NOTE: Due to requirements regarding secure transmission of confidential information, we cannot post forms that may be filled and submitted online. Medical Forms Medical Claim form (236K) Vision Claim Form (268K) (including eyeglasses and contacts) Coordination of Benefits (Multiple Coverage Inquiry Form) (247K) Incident Report Form (327K) (for accidental injuries) To obtain a Release of Information form, call 1-888-849-3681, or log in to your regence.com account. For an appeals form, you may log  More...
  • 4. If I disagree with what UMP covers, what should I do?
    The Public Employees Benefits Board (PEBB) is responsible for designing benefits for UMP Classic and UMP CDHP. If you would like to contact PEBB about what is covered, or to learn more about the process, see Who decides what UMP Classic/UMP CDHP covers? How can I get involved in the process? . If you disagree with decisions relating to the processing of your claim, the availability of a health care service or coverage, authorization or provision of health care services, or benefits you feel have  More...
  • 5. How does the independent review process work?
    What Is An Independent Review Organization? An Independent Review Organization (IRO) conducts 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 as well as evidence-based decision maki  More...
  • 6. Initial Application for Bariatric Surgery Consideration
    You can fill out this application online and click 'submit' OR download the paper form (123K) , print and mail it to: Attn: Appeals and Correspondence, M/S BU148 Regence BlueShield P.O. Box 2998 Tacoma, WA 98401-2998 Or by fax to: 1-877-663-7526 Please do not send any other paperwork or records at this time. If you cannot access the online or paper forms, contact UMP Customer Service at 1-888-849-3681.
  • 7. What can I do if UMP denies my pharmacy claim?
    Call Washington State Rx Services at 1-888-361-1611 to find out why the claim was denied. If you disagree with the reason for the denial, you may request an appeal. For more information, read about our UMP Complaint and Appeal Procedures .
  • 8. What is an "independent review"?
    To qualify for an independent review, you must have already gone through both a first- and second-level appeal with the plan. If you have received a second-level appeal decision from the plan and do not agree with the result, you may request an independent review. NOTE: Not all issues are eligible for an independent review. To contact us about independent reviews, call: Medical (not prescription drugs) services: 1-888-849-3681 Prescription drugs: 1-888-361-1611 See How does the independent rev  More...
  • 9. UMP definition: "experimental or investigational" services Updated
    Experimental or investigational means a service, supply, or drug that the plan has classified as investigational. The plan will review scientific evidence from well-designed clinical studies found in peer-reviewed medical literature, if available, and information obtained from the treating provider regarding the service, supply, or drug to determine if it is investigational. A service, supply, or drug not meeting all of the following criteria is, in the plan's judgment, investigational: A me  More...
  • 10. UMP Classic: Coverage of obstetric and newborn care
    See the list of covered provider types for providers whose services are covered by the plan. Effective January 1, 2015: Circumcision will be covered under the medical benefit . Services for pregnancy and its complications are covered. Professional services covered include: Prenatal and postnatal care. Amniocentesis and related genetic counseling and testing during pregnancy Prenatal testing (follows state regulations in Washington Administrative Code 246-680-020) Vaginal or cesarean delivery Car  More...

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

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