If you have problems with your health coverage, bills, claims, or access to care, help is available.
Common issues may include:
- Trouble enrolling in coverage
- Problems renewing benefits
- Denied claims or services
- Billing errors
- Difficulty finding a provider
- Delays getting prescriptions or care
- Problems understanding coverage or costs
Start with your health plan
Many issues can be resolved by contacting your health plan or coverage program directly.
You can ask for help with:
- Coverage questions
- Provider networks
- Billing concerns
- Prior authorizations
- Appeals and complaints
- Prescription coverage
Keep copies of:
- Letters or notices
- Medical bills
- Explanation of Benefits (EOB) forms
- Dates and names from phone calls
If you have Explore Health coverage and need help:
You have the right to appeal certain decisions, including:
- Eligibility determinations
- Coverage denials
- Financial assistance decisions
If you get a bill for services and have OHP, read this first.
If you have OHP and disagree with a decision about your benefits or eligibility, you may be able to:
- Request a hearing
- File a complaint
- Ask for help from your Coordinated Care Organization (CCO)
- Contact OHP Customer Service
CCOs can also help with:
- Finding providers
- Accessing care
- Care coordination
- Behavioral health or dental services
Veterans who experience problems with VA health care or benefits can:
Veterans may also be able to get help understanding how VA coverage works with Medicare, OHP, or Marketplace plans.
The Oregon Division of Financial Regulation (DFR) offers free consumer advocacy services to help people with private health insurance problems.
Consumer advocates may be able to help with:
- Denied claims
- Surprise medical bills
- Problems with insurance companies
- Access to prescription drugs or treatment
- Understanding your rights and coverage
- Filing complaints or appeals
DFR can help consumers understand health insurance laws and work with insurance companies to resolve issues.
Consumer advocates can also answer questions about:
- Individual or small group health plans
- Provider networks
- Mental health coverage
- Balance billing protections
- Appeals and external reviews
Help is free and available to people in Oregon.
Consumer protections
Health coverage programs and insurance companies must follow federal and state consumer protection laws.
You have protections related to:
- Access to emergency care
- Coverage for preventive services
- Nondiscrimination
- Privacy of health information
- Appeals and grievances
Some services may require prior authorization or have network rules, but plans must explain their policies and provide information about appeal rights.
Get free help
Free local help is available if you:
- Do not understand a notice or bill
- Need help filing an appeal
- Have trouble accessing care
- Need language or disability accommodations
- Want help understanding your rights and options
Local community partners, consumer assistance programs, enrollment assisters, insurance agents, SHIBA counselors, Tribal organizations, and Veteran Service Officers may be able to help.