Member FAQs - Cascade Select powered by CHPW - Cascade Select

Member FAQs

Community Health Network of Washington wants to make sure you have all the information you need to make the best health care choices. On this page, we answer some common member questions about Cascade Select coverage. If you have other questions, call our Customer Service team at 1-866-907-1906 (TTY: 711) Monday through Friday, 8 a.m. – 5 p.m.

I'm covered. How do I access care?

To make an appointment, call your clinic or doctor’s office. If you need help locating the phone number or finding a doctor, use our provider directory. Remember, CHNW Cascade Select is an Exclusive Provider Organization (EPO) plan, which means that we cover services only when you receive them from Network Providers, with limited exceptions such as emergency care.

When you call to make an appointment:

  • Tell them if you’re a new CHNW Cascade Select member.
  • Ask for an interpreter if you need one.
  • Have your CHNW Member ID handy in case the clinic staff needs information from it.

If you need help making an appointment, call our Customer Service at team 1-866-907-1906 (TTY: 711) Monday through Friday, 8 a.m. – 5 p.m.

How do I know if I should see a doctor?

You can get care in a variety of ways. The type of care you seek largely depends on your medical issue.

  • Primary Care Provider: See your primary care provider for routine care like checkups and immunizations, if you’re managing a chronic illness, if you need a referral to a specialist, or if you get something like mild allergies or a cold and you do not need immediate attention.
  • Nurse Advice Line: CHNW members have access to advice from professional nurses 24 hours a day, seven days a week at 1-866-418-2920 (TTY: Dial 711). If you are not feeling well and unsure of what kind of care you need, the Nurse Advice Line, powered by CHPW, can help you decide what type of care to seek. The nurse can also refer you to a virtual care visit with a doctor.
  • Virtual Care: Some health care providers and clinics offer doctor’s visits over phone or video. This allows you to get medical care without leaving your home. If your doctor’s or provider’s office doesn’t offer virtual care (also known as telehealth or telemedicine) or is closed, don’t worry — you can access doctor services 24/7 through CHPW’s telehealth service, CHPW Virtual Care.
  • Urgent Care: Urgent care offers non-emergency care 24 hours a day. It helps fill a vital gap for when you become sick or injured, but your regular doctor is not available and you can’t wait for an appointment. Examples of urgent care issues: You suddenly get a fever, you experience vomiting or persistent diarrhea, you have small cuts that may require stitches.
  • Emergency Room: The emergency room is open 24 hours a day, seven days a week. It is for serious injuries or issues with life-threatening symptoms. Some examples of issues that would need emergency care are: severe burns, auto accidents, shortness of breath, chest pain, severe stomach pain, bleeding that won’t stop.
How can I find cost information for treatment?

If you are looking for information on the estimated full costs of a treatment and your estimated out-of-pocket costs, we’re happy to go over that with you.

Information is available for common treatments within the following categories: 

  • Inpatient treatments
  • Outpatient treatments
  • Diagnostic tests
  • Office visits

Please call our Customer Service at 1-866-907-1906 (TTY: Dial 711) Monday through Friday, from 8 a.m. to 5 p.m.

What if I want a second opinion about my health care?

You have the right to get a second opinion.

Tell your primary doctor that’s what you want. They will refer you to a different provider, or you can choose one from our provider list. Coverage, including the amounts you are responsible to pay, depends on whether you see an in-network or out-of-network provider. 

What is utilization management?

Utilization management is a process of reviewing whether care is medically necessary and appropriate for patients. 

We evaluate care before it’s given (prior authorization), while it’s being given (concurrent review), and after it’s given (post-service review). Certain services, such as visiting a PCP or an in-network specialist, do not require utilization management review. 

Who does the review?

The review is done by the appropriate licensed staff, which includes nurses, social workers, pharmacists, and physicians. CHNW staff is available to discuss any utilization management process, authorization, or denial. All inpatient admissions and certain outpatient services and procedures require prior authorization.

My doctor submitted a prior authorization request. How long will it take to hear back?

Typically, a standard request must have a decision and provide notification within five calendar days of receiving the request from your doctor. If we need additional information from your provider, this time is extended. You will be notified via mail once a decision is made.

In some instances, your provider may determine that coverage of a certain request should be decided urgently. In these cases, an urgent request will have a decision within two calendar days of receipt of the request from your doctor. If we need additional information from your provider, this time is extended.

Can I see a doctor who is not on your provider list?

As a CHNW member, you must choose an in-network Primary Care Provider (PCP) to get your medical care, with limited exceptions such as emergency care and cases where you have obtained prior authorization from your CHNW doctor. If a covered service is not available from a network provider, your PCP will assist you in getting a referral to an appropriate out-of-network provider. When you get a referral to an out-of-network provider, you will be covered the same as with an in-network provider.

How can I change my doctor?

You can change your doctor because you’ve moved, or if you would feel more comfortable with another doctor. Whatever the reason, you can change from one in-network CHNW provider to another at any time:

  • Call us. Our Customer Service team will be happy to help you change doctors.
  • Log into your myCHNW member portal. In your myCHNW dashboard, navigate to Member Self Services > Update PCP (Primary Care Provider).
How do I know if my medication is covered?

Each year, we publish a formulary, or list of covered drugs. You should review this list to determine what tier your drug is on and if there are any restrictions on it.

Where can I fill my prescriptions?

You can have your prescriptions mailed to your home. Here are 3 simple ways to get started with home delivery.

  • ePrescribe: Ask your doctor to send your prescriptions electronically to Express Scripts Pharmacy.
  • Phone: Call 1-888-637-8383. Available 24 hours a day (including holidays), 7 days a week to talk about getting your long-term medicine delivered. TTY users: 1-800-759-1089.
  • Online:  Visit express-scripts.com or download our mobile app for free. You need to register with your member ID card. Follow the prompts to move your prescriptions to home delivery.

CHNW also has a network of pharmacies. Many of our Community Health Centers have their own pharmacies. To find the pharmacy closest to you, you can:

Bring your CHNW ID card when you pick up your prescription. 

*CHNW partners with Express Scripts to give you access to a large network of participating pharmacies and range of covered prescriptions. Go to Express Scripts to log in or create an account. From your account, you can manage prescriptions, search for pharmacies, and learn important safety information about your medicine.

How do I submit a Prescription Drug or Medical Coverage claim?

Most providers will submit their bills to us directly. Sometimes when you get medical care or a prescription drug, you may pay directly. Other times, you may find that you have paid more than you expected under the coverage rules of the plan. In either case, you can ask our plan to pay you back.

To be paid back for covered services or drugs, please send us your request along with your bill and documentation of the payment you made. 

For Prescription Drug Coverage payments, please mail your request for payment together with any bills or receipts to us at this address:

Express Scripts, Inc.
Attn: Commercial Claims
P.O. Box 14711
Lexington, KY 40511-4711
Fax: (608) 741-5475

For Medical Coverage payments, please mail your request for payment together with any bills or receipts to us at:

Community Health Network of Washington Cascade Select
ATTN: Claims
1111 3rd Ave Suite 400
Seattle, WA 98101

You should submit all claims within 90 days of the start of service, or within 30 days after the service is completed. The claim must be submitted to us within 365 days of the date you received the service, item, or drug.

Updating personal information and contacting the plan

How do I contact the plan?

CHNW is here to answer your questions and address your concerns, so you can choose the easiest way to get in touch:

  • By phone. Call us at 1-866-907-1906 (TTY: 711). We’re available to take your calls Monday through Friday, from 8 a.m. to 5 p.m.
  • By email. Email us any time of day or night at [email protected], and we’ll get back to you Monday through Friday, from 8 a.m. to 5 p.m.
  • Through the myCHNW portal. In your myCHNW dashboard, navigate to Member Self Services > Secure Messages. Secure messages are like emails, but they can only be accessed through myCHNW.
I’ve moved. How do I change my address and/or phone number?

When you move, be sure to let Washington Healthplanfinder know.

Then call Community Health Network of Washington. We’ll update your address and other information. We can also help you choose a new Primary Care Provider, if necessary.

To get in touch with us, call Customer Service at 1-866-907-1906 (TTY: 711), 8 a.m. to 5 p.m., Monday through Friday.

What if my income changes?

Reporting changes is important so your information stays up to date and so that you get the right amount of financial help. The easiest way to report changes is through your Washington Healthplanfinder account online.

  1. Log in to your Washington Healthpanfinder account.
  2. Select “Report a Change” on your dashboard.
  3. Select the change you’d like to report. Answer the questions that apply to you and follow the pages to update your information.

Need help? Call Washington Healthplanfinder at 855-923-4633. Or call CHNW Customer Service at 1-866-907-1906 (TTY: 711).

I have just had a baby and would like to enroll them into Cascade Select. How do I do that?

Congratulations! Please call Washington Healthplanfinder at 855-923-4633, and they can get you started.

What is myCHNW?

myCHNW is our online portal that lets you view important coverage information. It can be accessed from a phone, tablet, or computer.

With myCHNW, you can:

  • See information for all your different insurance plans, not just ours.
  • See your coverage information and benefits.
  • See your claims.
  • Check the status of your authorizations and referrals.
  • Order a copy of your CHNW ID card.
  • Search for providers and facilities.
  • Ask us to change your primary care provider.
  • Update your contact information.
  • Ask our Customer Service team questions through our secure system.
  • Get private notifications and general updates.
  • Learn more about benefits and claims.
  • Review your Explanations of Benefits (EOB) in myCHNW. An EOB is a statement that lists the services you got, the amount billed, and what was paid.
What if I am not happy with my services and care?

You have the right to excellent care. To file a grievance (a complaint) about services or care you’ve received, call us at 1-866-907-1906 (TTY: 711). We’re available to take your calls Monday through Friday, from 8 a.m. to 5 p.m.

If you have additional questions, please contact Customer Service for assistance at 1-866-907-1906 (TTY: 711). Our local, friendly team is available Monday through Friday, from 8:00 a.m. to 5:00 p.m.

DID YOU KNOW...?

Stay on Top of Your Prescriptions

Woman grabbing a prescriptionDid you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.

LEARN MORE