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Oregon Health Plan client complaints and appeals
Learn more about what clients can do when they disagree with a plan or DMAP decision about paying for health care services.
 

 OHP-Faqs

 
  
Answer
How do I send in a complaint about OHP or my plan?

OHP Complaint Form - Use this form to submit complaints to OHP Client Services or your plan.

If DMAP or the plan denies coverage of a service that has already been delivered, can an OHP member appeal the denial?

All OHP members can file a request for hearing if they disagree with a payment decision. Members of OHP health or dental plans who disagree with the plan’s denial of payment can also appeal the decision with their plan.

The OHP member is only responsible for payment if he or she signed a waiver agreeing to be responsible for payment of the non-covered service.
How can OHP members request a hearing?

The OHP member must complete the Request for Administrative Hearing (MSC 443) within 45 calendar days of date on the Notice of Action.​

Can a provider represent an OHP member in an appeal regarding the denial of payment for services?

The OHP member can designate anyone as his or her representative in an appeal or hearing. The member must provide written consent.​

Do OHP members have appeal rights when they are disenrolled from an OHP health or dental plan?

Yes. Our rules list the conditions for disenrollment. The plan must meet those conditions before we will approve the request for disenrollment. (See OAR 410-141-0080 and 410-141-3080).​