CHPW Apple Health information
This page contains useful information about how we provide health care coverage and your rights as a CHPW Apple Health member. Items followed by an asterisk (*) mean that information can be found in your Member Handbook. For more details or paper copies of any of these items, contact Customer Service at 1-800-440-1561 (TTY: 711), Monday through Friday, 8 a.m. – 5 p.m.
Getting started
- How to get language assistance and if you need information in a different language or format
- The availability of TTY services for members
Getting care
- How to get primary care services, including points of access*
- How to access 24/7 virtual care services*
- How to get care after normal office hours*
- How to get specialty care, behavioral health services, and hospital services*
- How to access emergency care and emergency rooms, including our policy on when to directly access emergency care or use 911 services*
- How to access care, services, covered and non-covered benefits outside the service areas*
- How to get information about in-network and out-of-network practitioners, including professional qualifications of in-network primary care and specialty care providers
- 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*
Benefits and coverage
- Benefits and services included in, and excluded from, coverage*
- How we evaluate new technology to include as a covered benefit*
- Copayments and other charges for which you are responsible*
- How you may submit a claim for covered services, if applicable*
- Restrictions on benefits that apply to services obtained outside our service areas*
- Prescription Drugs benefits and Pharmaceutical Management procedures*
Special programs
- Our Quality Improvement Program, including goals, processes, and outcomes in terms of care and service
- Our Care Management Program and how you and your caregiver may self-refer to the program
- Our Health Management Programs and how you may self-refer to the 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 711) when you have questions about Utilization Management (UM) issues, such as authorization dates or questions about denials*
- Information about how to obtain language assistance to discuss UM issues
- 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 submit 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
Apple Health Handbook
Download the member handbook to learn more about medical and behavioral health benefits and services covered through Apple Health, including Apple Health Expansion:
➔ Medical and Behavioral Health Benefit Book (English) | English (Large Font) | Español – Spanish | العربية – Arabic |中文 – Chinese | دری – Dari | Pусский – Russian | af Soomaali – Somali | українська – Ukranian | Tiếng Việt – Vietnamese
