• Contact CUP Member Services Department by phone, writing, or in person.
• We will investigate your grievance and follow-up as required.
• We will respond to your grievance within 30 days.

Your grievance is very important to us. We want to know how you feel about your care.

APPEAL PROCESS:  CUP providers want to give you the best health care possible. If you have a referral or claim that has been denied, you have the right to appeal the decision. You must request an appeal within 6 months of the service denial. Our Member Services Department will help you through the appeal process. To file an appeal, you may call or write to the Member Services Department at the following address and phone numbers:

CUP Member Service Department
19120 SE 34th St., Suite 201, Vancouver, Washington 98683
(360) 891-1520, (800) 315-7862, TDD (360) 449-8860
or Toll Free TDD (866) 287-9962.

Basic Health members have the right to appeal to CUP.

LEVEL 1: CUP’s Medical Advisory Committee will acknowledge receipt of your appeal within 5 days and will review your appeal. You will receive a letter telling you of the Committee’s decision. A letter will be sent to you with the Committee’s decision within 14 working days of your appeal. If this is not possible, a letter will tell you the reason for the delay. (An additional 15 working days may be requested.) Information about your appeal will be kept private. A letter will be sent to you with the Committee’s decision within 14 working days of your appeal request.

EXPEDITED APPEAL: If you or your doctor feels your health may be harmed in any way you may request an expedited appeal. A decision will be made within 72 hours of receipt of your request.

If CUP does not meet these timelines stated above, you have a right to appeal directly to an Independent Review Organization.

INDEPENDENT REVIEW ORGANIZATION: If you do not agree with CUP’s decision you may ask CUP to have an Independent Review Organization (IRO) review your case. CUP will refer your case to the IRO within three days of your request. You will be contacted and given the IRO’s decision within 15 days of CUP’s receipt of the independent review request. If additional time is necessary for a final determination the IRO will notify you that an additional 10 working days is needed to complete your review. If we do not let you know the IRO’s decision within the number of days listed above, we will approve the service. Any ongoing services will be continued during this process, but you may have to pay for the services if CUP’s decision to deny the service is not changed by the IRO. Information about your IRO request and findings are kept private.

EXPEDITED APPEAL: If you or your doctor feels your health may be harmed in any way by waiting you may request an expedited IRO review of your case. A decision will be made within 72 hours of receipt of the expedited IRO review request.

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