Report Fraud and Abuse

Fraud and abuse are the number one threats to our healthcare system, costing Americans billions of dollars each year. Healthcare fraud is the intent to deceive a company into paying for services that either were not or should not have been provided. Those breaking the law could be physicians, patients, laboratories, hospitals, employees, vendors, or a billing service used by a provider. 

Learn more about how to report fraud and abuse.

File a Grievance

To report a concern regarding Western Health Advantage, our network providers, or if you are unhappy with the care or service you received, please contact Member Services. We will try to resolve any problem you might have over the phone. Member Services can also assist you with submitting a written grievance. You can also start the grievance process by filling out the secure online form.

Learn more about filing a grievance.

Privacy Practices

Western Health Advantage respects your privacy and protects your electronic, written and oral health information throughout our organization. All staff must complete training on the legal and ethical obligations to protect the privacy of member information. Additionally, we limit physical access to the WHA facility and password protect our electronic databases and limit staff access to only the health information they need to do their job.

Learn more about WHA's privacy practices.

Non Discrimination

Western Health Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age or disability.  Western Health Advantage provides free aids and services to people with disabilities to communicate effectively with us.

View WHA's non discrimination notice.

Language Assistance 

Western Health Advantage understands how important it is to be able to effectively communicate with your health plan or health care provider. Western Health Advantage provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

This notice is available in other languages.

Terms of Use

Your use of this site is subject to the terms and conditions of this agreement.  By accessing, using and/or viewing our site, you hereby agree to be bound by the terms of this agreement and you agree to the terms of WHA's internet privacy practices.  If you do not agree to these terms and conditions, you must exit this site.

View the full Terms of Use.

Code of Business Conduct

Western Health Advantage’s Code of Business Conduct helps guide all Associates in performing our business activities within ethical and legal standards. The Code ensures that we comply with ethical standards and applicable laws and regulations appropriate to our business. The Code is designed to promote the prevention, detection, and resolution of conduct that does not comply with company policies in addition to state and federal laws and regulations.

View the full Code of Business Conduct.

SMS Terms and Conditions

WHA provides members with the opportunity to interact with WHA via text messages. You verify that any telephone information provided to WHA is true and accurate, and that you are the authorized user of the mobile device and owner of the mobile phone number provided. You acknowledge that by voluntarily providing your telephone number, you expressly give WHA permission to send text messages to the telephone number provided, including but not limited to, general health communications relating to your account, billing notifications, payment notices, and new services available to members. Participating is voluntary. You may opt out of SMS messages at any time, by replying STOP to any text. You will receive one final text acknowledging receipt of your STOP request. You may opt back in to SMS messages by contacting Member Services. Please check with your wireless carrier for details regarding applicable message and data rates that may apply. Neither WHA nor wireless carriers are responsible or liable for delayed or undelivered messages. You acknowledge that text messages are not fully secure and that there is some level of risk that information you receive in an unencrypted text message could be intercepted by a third party or read by others. You understand and accept this risk and would like WHA to communicate with you via this method.

Quick Links

Dollar Fee

Last review date: March 11, 2021