Plan information for BHSO members - Washington State Local Health Insurance - CHPW

Plan information for BHSO members

CHPW BHSO information

This page contains useful information about how we provide health care coverage and your rights as a CHPW BHSO member. For more details or paper copies of any of these items, contact Customer Service at 1-800-440-1561 (TTY Relay: 711), Monday through Friday, 8 a.m. – 5 p.m.

Getting started

Getting care

  • How to get specialty care and behavioral health services and hospital services*
  • How to get care after normal office hours*
  • How to get emergency care, including our policy on when to directly access emergency care or use 911 services*
  • How to get care and coverage when you are out of our service area*
  • How children under 21 years of age may get Early Periodic Screening, Diagnosis and Treatment services that include regular checkups and medically necessary follow-up treatment*
  • How to access virtual care (telehealth) services

Benefits and coverage

Special programs

Utilization Management (our process of reviewing whether care is medically necessary and appropriate)

  • The toll-free number to call (1-800-440-1561; TTY dial 711) when you have questions about Utilization Management (UM) issues, such as authorization dates or questions about denials*
  • Our policy prohibiting financial incentives for UM decision-makers:
    • UM decision-making is based only on appropriateness of care and service and existence of coverage
    • The organization does not specifically reward practitioners or other individuals for issuing denials of coverage
    • Financial incentives for UM decision makers do not encourage decisions that result in underutilization
  • A description of the availability of an independent external appeals process for utilization management decisions made by Community Health Plan of Washington

Your rights and privacy

  • Our Member Rights and Responsibilities statement
  • How a member may complete an advance directive. An advance directive puts a member’s health care choices into writing and may name someone to speak for the member, if he or she is unable to speak. Advanced directives may include a Health Care Directive, Living Will, or a Durable Power of Attorney
  • How to voice a complaint
  • How to appeal a decision that adversely affects coverage, benefits, or your relationship with us
  • Our notice of privacy practices and confidentiality policies including:
    • How we use authorizations, and your right to approve the release of personal health information (PHI)
    • How to request restrictions on the use or disclosure of PHI, amendments to PHI, access to your PHI, or an accounting of disclosures of PHI
    • Our commitment to protect your privacy
    • Our policy on sharing personal health information with Plan sponsors and employers

*Information can be found in Member Handbook

LEARN MORE ABOUT US

[random_content group_id='19' num_posts='1']

☏ HAVE QUESTIONS ?

Sales Team

Get real answers
from real people

Phone: 1-800-440-1561
[email protected]

x