Grievance and Appeal Process

CUP and its providers want to give you the best health care they can.
There are times when you may not be happy with your service. There are times when CUP may deny you or your doctor’s request for a service or payment for a claim.

The grievance process is a way for you to tell us about your concerns.
The appeal process is a way for you or your doctor to ask CUP to review the denial of a service or a claim for payment.

As a CUP member you have the right to a second opinion from another provider when you disagree with the initial provider's treatment plan.  If you want information on the process for getting a second opinion, contact our Member Services Team at the phone number below.

For details on how to enter a Grievance or an Appeal click here 

If you have questions on the process, please contact our Member Services Team at 360.891.1520 or 800.315.7862.  One of our representatives will provide whatever help you need to enter a grievance or an appeal.

Exception to Rule - You or your provider may request that CUP pay for a non-covered service by exception.  For CUP to consider this request, your provider must submit enough information, specific to you, that shows your medical condition is different from the majority and that there is no equally effective, less costly covered service that meets your needs. This process is called Exception to Rule.  Your request must be submitted to CUP in writing within 90 days of the date of thisletter.

Limitation Extension - This is the request for extended scope, amount, duration, and/or frequency of a covered healthcare service.  When a limitation extension is not prohibited by specific program rules, the member's provider may request a limitation extension as long as the healthcare service is within the scope fo the member's healthcare program.