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:

• Atrio Health Plans
• BridgeSpan
• Health Share of Oregon
• Kaiser Permanente
• Moda Health
• PacificSource Health Plans
• Providence Health Plan
• Regence BlueCross BlueShield of Oregon
• My plan isn’t listed

 

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.