• The issue is related to admission, availability of care, continued stay, or emergency health care services and you have not been discharged from the emergency room or transport service. You may authorize a representative to submit an expedited appeal on your behalf in writing or by contacting UMP Customer Service. An expedited appeal replaces both the first- and second-level appeals. Regence BlueShield will call you, or your authorized representative, with a decision on your expedited appeal within 72 hours of the request. Regence BlueShield will also mail a written response within 72 hours of the decision. Your provider must submit all clinically relevant information to the plan by phone or fax at: • Phone: 1-888-849-3682 (TRS: 711) • Fax: 1-877-663-7526 If you disagree with the expedited appeal decision, your provider may request an expedited external review (see the “External review (independent review)” section below). Expedited appeals for prescription drugs You or your authorized representative may submit an expedited appeal within 180 days of receiving the previous decision if you or your provider thinks you need a prescription drug immediately. You may authorize a representative to submit an appeal on your behalf in writing or by contacting WSRxS Customer Service. An expedited appeal replaces both the first- and second-level appeals. WSRxS will call you, or your authorized representative, with a decision on your expedited appeal within 72 hours of the request. WSRxS will also mail a written response within 72 hours of the decision. You or your provider must submit all clinically relevant information to the plan by phone or fax at: • Phone: 1-888-361-1611 (TRS: 711) • Fax: 1-866-923-0412 During an expedited appeal, you may choose to purchase a three-day supply at your own expense. If WSRxS decides to cover the prescription drug, WSRxS will reimburse you up to the allowed amount minus the member cost-share (coinsurance and deductible, if applicable). If WSRxS decides not to cover the prescription drug (denies the appeal), you are responsible for the full cost of the drug. If you disagree with the expedited appeal decision, you or your provider may request an expedited external review (see the “External review (independent review)” section below). Time limits for the plan to decide appeals ALERT! The plan will comply with shorter time limits than those below when required by federal or Washington State law. The time limits for both first- and second-level appeals are calculated from when the plan receives the appeal. The plan will decide your appeal within 14 days of receiving it but may take up to 30 days unless a different time limit applies as explained below. The plan will request written permission from you or your authorized representative if an extension to the 30-day time limit is needed to get medical records or a second opinion. 128 2024 UMP CDHP (PEBB) Certificate of Coverage