Oregon

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. By Oregon law, complaints must be resolved within 30 days. Follow the steps below to file a complaint and appeal with your health plan:

  • Call the member/customer service phone number for your health plan.
  • Tell them you want to file a formal complaint and then explain the problem.
  • You can also file your complaint by letter, email, or online through your health plan’s website (see below).
  • If you disagree with your health plan’s decision, you have the right to file an appeal through your health plan’s website (see below).
  • If your health plan rejects your appeal, you have the right to an external review.
  • Contact the Division of Financial Regulation for help with the appeals process and to apply for an external review: (866) 814-9710.

Below are links to the complaint forms of Oregon‘s top health plans:

 

Medicare Plans

 

STEP TWO – File a Complaint

You have the right to file a complaint with the Oregon Division of Insurance (DOI) if you have a problem getting the services you need, including quality and affordable health care. Once the DOI receives your complaint, an advocate will advise you of their findings within 60 days.

  • File a complaint with the DOI’s Consumer Advocacy Unit online here.
  • Call the Consumer Advocacy Unit’s helpline: (888) 877-4894.
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Know Your Rights

State and federal law protects your rights. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights.