Plan information for CHPW Apple Health members - Washington State Local Health Insurance - CHPW
Community Health Plan of Washington Apple Health Medicaid Plan Community Health Plan of Washington Apple Health Medicaid Plan

Plan information for CHPW Apple Health members

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 Relay: 711), Monday through Friday, 8 a.m. – 5 p.m.

Getting started

Getting care

  • How to get primary care services, including points of access*
  • 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 to get information about network practitioners, including professional qualifications of 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*
  • 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*
  • 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

Download the 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


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Phone: 1-800-440-1561
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