Explore Health wants to make sure people are treated fairly and receive good customer service.
If you have a problem, concern, or believe a mistake was made, you can file a complaint or grievance.
Complaints
You can file a complaint about:
- Eligibility decisions
- Financial help amounts
- Special Enrollment Period decisions
- Plan cancellations or terminations
- Coverage start dates
- Customer service concerns
- Other Explore Health issues
You can submit a complaint:
- Through your Explore Health account
- On the Explore Health website
- By calling the Contact Center
Some insurance issues, like claim denials or billing problems, may need to be handled directly by your insurance company.
Grievances and discrimination concerns
You have the right to be treated fairly.
Explore Health does not allow discrimination based on:
- Race
- Color
- National origin
- Age
- Disability
- Sex, including pregnancy, sexual orientation, and gender identity
You may file a grievance if you believe you were treated unfairly or discriminated against.
Explore Health will not retaliate against anyone for filing a grievance or reporting discrimination.
Grievances should usually be filed within 60 days of the incident.
Filing a civil rights complaint
You may also file a discrimination complaint directly with the U.S. Department of Health and Human Services Office for Civil Rights.
Complaints generally must be filed within 180 days of the incident.
Oregon Division of Financial Regulation (DFR)
You can contact the Oregon Division of Financial Regulation (DFR) for help with:
- Insurance claim problems
- Suspected fraud
- Insurance company complaints
- Misleading marketing or enrollment concerns
Contact DFR
How Explore Health handles concerns
Explore Health tracks complaints, grievances, appeals, and correction requests to help make sure issues are reviewed and resolved fairly and accurately.