a representative to submit a request for an external review on your behalf in writing or by contacting UMP Customer Service (medical appeals) or WSRxS Customer Service (prescription drug appeals). The plan — Regence BlueShield for medical services, and WSRxS for prescription drugs — will send the IRO all of the relevant information and correspondence they considered in making the decision. You may send more information directly to the IRO. The IRO will notify you of their decision. Additional legal options You are required to exhaust the plan’s appeals process before you may bring a cause of action in court against the plan or HCA. If an IRO reviews your appeal, their decision is binding on both the plan and you except to the extent that other remedies are available under state or federal law. If the IRO overturns the plan’s decision the plan will provide benefits (including making payment on the claim) according to the IRO’s decision without delay, regardless of whether the plan intends to seek judicial review of the IRO’s decision and unless and until there is a judicial decision otherwise. Complaints about quality of care For complaints or concerns about the quality of care you received from network providers only, contact UMP Customer Service or send a secure email through your Regence account (see Directory for link and contact information). For complaints or concerns about the quality of care you received from any provider: • Call Washington State Department of Health at 360-236-4700 (TRS: 711) or 1-800-562-6900 (TRS: 711). • Email the Department of Health at [email protected]. • Visit the Department of Health website at doh.wa.gov/about-us/file-complaint. Appeals related to eligibility Appeals related to eligibility and enrollment are handled by the PEBB Program and governed by chapter 182-16 WAC. Information on how to file an appeal is available: • On the HCA website at hca.wa.gov/pebb-appeals. • By contacting the PEBB Appeals Unit at 1-800-351-6827 (TRS: 711). Where to send complaints or appeals ALERT! VSP handles appeals for routine vision benefits. See “Your routine vision benefits” for more information. It is recommended that you call first with a complaint or appeal, since many problems may be resolved quickly over the phone. The Directory at the beginning of this booklet includes links and contact information to contact UMP (medical services) or WSRxS (prescription drugs) with a complaint or appeal. 130 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage