Response to Consent Order from the Office of the Insurance Commissioner

Date: 05/17/18

Dear Member:

Ambetter from Coordinated Care Corporation is reaching out to current and former members pursuant to Consent Order No. 17-0477 from the Washington State Office of the Insurance Commissioner (OIC).  As part of our response to issues identified by the OIC, we want to ensure you are fully informed of your rights as a healthcare insurance consumer. 

We have discovered that members may have had difficulty in obtaining health benefits, care, or were charged more for services than expected. We want to resolve any past or ongoing issues. Please contact us if:

• You received emergency care or authorized hospital or outpatient surgery services, and feel you were billed for amounts in excess of your deductible because you were seen by an out-of-network provider, such as an emergency room doctor, anesthesiologist, radiologist or for lab/ pathology services.
• You received care from an in-network provider, and feel that you were billed or paid amounts in excess of your deductible and/or coinsurance.
• You needed care and had to seek care from an out-of-network provider due to problems locating a nearby in-network Ambetter provider.

What are my rights as a member?

You have the right to appeal any denial of service or benefits.  Appeals have two levels of review; the first level is for Ambetter to review its initial denial.  If the review involves medical necessity denials, the review is done by a different physician than the one who made the initial denial decision.  If Ambetter upholds the initial denial decision, you have the right to request your appeal go through a second level of external review by an Independent Review Organization approved by the OIC.  You may also contact the OIC directly. 

Who should I contact?

We have provided a special toll free number below, so you can reach us if you have unresolved issues.  In order to help review your concerns we may ask you for the following information to help resolve any outstanding issues:

• Your name
• Your member ID number
• A phone number where we can reach you
• A list of the services or benefits you believe were improperly denied
• Information to help us understand the specifics related to any service or benefit denial
• Any other information that supports your request

Please contact us at:

Special Toll Free Number:  844-238-0300
8 a.m. and 5 p.m. Monday - Friday

Mailing Address:

Grievances Coordinator
Coordinated Care
1145 Broadway, Suite 300
Tacoma, WA 98402
Fax Number: 855-218-0588

Member Portal

https://ambetter.coordinatedcarehealth.com/resources.html

Secure Messaging is available

Please label the Subject Line in your request

“Remediation of Consent Order”

NOTE:  If you prefer, you also have the option to contact the Office of Insurance Commissioner directly.

The OIC can be contacted directly at 800-562-6900.

Ambetter from Coordinated Care is here to help. Our customer service team will work with you if you need assistance locating a provider or getting an appointment. If you experienced delays in accessing care or additional costs for out-of-network care that have not been resolved, we would like to hear from you so we can address and resolve those issues.

Thank you for choosing Ambetter from Coordinated Care.

Sincerely,

Ambetter from Coordinated Care