Wash. Rev. Code § 48.43.535

Independent review of health care disputes--System for using certified independent review organizations—Rules

An individual may obtain an independent review of their health carrier’s decision to deny, modify, or terminate their health coverage or payments made on their behalf so long as the individual has exhausted the health carrier’s internal grievance process.

Carriers must release the enrollee’s relevant medical records to the independent review committee and any documentation used by the carrier to make the coverage decision in controversy. Carries must also provide the independent review committee with a list of health care providers that may have medical records relevant to the enrollee’s appeal. The Commissioner will adopt rules regarding the release of confidential and proprietary information to the independent review committee. Enrollees must have at least five days to provide the independent review committee with information relevant to their appeal.

Independent review organizations must keep records of their activity and must provide the Commissioner with access to these records upon their request.