Out-of-Network Waiver Request Process

The out-of-network waiver is completed and submitted only by an in-network primary care provider. All patient inquiries will be directed back to the provider office. If you are a specialist, please redirect waiver inquiries to the patient's in-network primary care provider.

If the patient needs assistance establishing an in-network provider, they may contact Embright's call center:

  • Boeing: (888) 402-4235
  • PEBB: (888) 402-4237
  • SEBB: (888) 402-4238

Waivers cannot be reviewed unless all the following criteria have been met:

  1. Identify the reason for out-of-network services.
    • Confirm resources are not available within the Embright network by consulting the following directories:
    • Verify the patient requires ongoing out-of-network services for continuity of care related to an active treatment plan.
  2. Validate services are anticipated in the future and have not already taken place.
  3. Complete the waiver form.
  4. Provide chart notes and other supportive documentation clarifying the necessity of the service and treatment plan.
  5. Fax completed waiver and comprehensive notes to (206) 589-6600.

Documents will be reviewed for final determination within five business days. Incomplete submissions will not be reviewed.

The waiver must be submitted and approved before your patient can receive care from the out-of-network provider or facility. Submitting or having an approved waiver request does not guarantee services will be covered under their health plan. Patients retain the option of seeking out of network care and should consult their health plan for information related to their benefits or level of coverage.