The North Sound Behavioral Health Ombuds provide advocacy for anyone applying for or receiving publicly-funded behavioral health services in Island, San Juan, Skagit, Snohomish and Whatcom Counties. Call your local Ombuds if you feel that your rights have been violated or that you are not receiving adequate services. Ombuds’ goal is to assist you in obtaining a resolution that meets your needs. Services are confidential and free. The law protects you from any kind of retaliation.
- Listen to the concern
- Research the situation
- Assist with information/referrals
- Provide advocacy and support
- Provide education about the behavioral health system and your rights
- Assist in resolving concerns that meet your needs
- Assistance through the complaint, grievance, appeal, administrative hearing and board of appeals process
- Assist you in completing behavioral health related paperwork
- Provide behavioral health counseling, case management or crisis services
- Enforce a recommendation
- Give legal advice
- Guarantee a specific outcome
Know Your Rights
Each individual that accesses publicly funded behavioral services has rights. Click on the links below to know what some of your right are in Washington State:
If you are unhappy with your publicly funded behavioral health services, Ombuds can help you submit a complaint. You may also choose to do this process without assistance. The complaint process varies depending on who provides the behavioral health service and may be submitted verbally or in writing.
A “grievance” is an expression of dissatisfaction about any matter other than an action. Grievances can be filed with the payer of your behavioral health service. Depending on what service you have a concern with, will also depend on who the grievance is submitted to. This can be one of five Managed Care Organizations (MCO) or the North Sound Behavioral Health Administrative Services Organization (NSBH-ASO). Grievances are longer process then a complaint and can take up to 45 days to find a suitable resolution. Grievances Examples:
- The quality of care or services provided
- Aspects of interpersonal relationships such as rudeness of a provider or employee
- Failure to respect your rights
An “appeal” is a request for the review of an action, when services are denied, reduced, or terminated by the NSBH-ASO or MCO. You have 60 calendar days of receiving your Notice of Action letter to file an appeal. An appeal can take 14 days or 3 day Expedited Appeal if the action will affect your health and welfare. The appeal is a review of the action for which there are two outcomes; uphold the denial or overturn the denial. You may file the appeal directly with NSBH-ASO/ MCO or you may or contact your local Ombuds for assistance.
An individual, or their authorized representative, must first complete the appeals process before filing for an administrative hearing. An administrative hearing is filed when the individuals does not agree with the resolution of the appeal. This process can take up to 120 calendar days. You may use Ombuds services or contact Office of Administrative Hearings: 1-800-583-8271.
Health Care Authority Board of Appeals
After the Administrative Hearing has been completed and you are not satisfied with the result, you have the right to ask for a final review by a HCA Board of Appeals Judge. The decision of the Board of Appeals is final decision.
*Please note that Ombuds program advocates for your needs by resolving the concern at the lowest level possible. If you choose to file a grievance, though there is no statute of limitations, you may only grieve a topic once.