If you are very unhappy with Health Share, your health care services or your provider, you can complain or file a grievance. We will try to make things better. Just call Customer Service at 503-416-8090, 1-888-519-3845 or TTY/TDD 711, or send us a letter to the Health Share address below.
Health Share of Oregon
2121 SW Broadway, Suite 200
Portland, OR 97201
We will call or write back immediately and attempt to resolve the issue within five days. If we are unable to resolve the issue in that timeframe, we will notify you in writing. We will commit to resolving your issue within 30 days and will send you a letter in 30 days explaining how we will address your complaint. We will not tell anyone about your complaint unless you ask us to.
Below are links to the forms and information you will need:
If we deny, stop or reduce a service your provider has ordered, we will mail you a Notice of Action/Benefit Determination letter, telling you why we made the decision. You may ask to appeal the denial. Follow the instructions on the Notice of Action/Benefit Determination letter to begin the appeal process. You must file the appeal within 60 days of the date of the Notice of Action/Benefit Determination letter. If you choose to file an appeal, health care professionals with clinical knowledge of your condition will review it. We will mail you a Notice of Appeal Resolution letter as quickly as your health condition requires, but no longer than 16 days after the date of your request. You can keep getting a service that was already started before our decision to deny, stop or reduce it. You must ask to keep getting the service within 10 days of the date of the Notice of Action/Benefit Determination letter. If the health care professional who reviews your appeal agrees that the original decision was correct, you may have to pay for the continued services you received after the date of the Notice of Action/Benefit Determination letter. If you believe that your health condition cannot wait for a regular appeal, you can ask Health Share for a fast (expedited) appeal. You should include a statement from your provider about how your health could be harmed by waiting for the regular a ppeal process. If Health Share agrees that it is urgent, we will call you with a decision in 72 hours.
If you are not happy with the original denial decision or the appeal decision, you can ask the Division of Medical Assistance Programs (DMAP) for an Administrative Hearing. Your Notice of Appeal Resolution Letter will have instructions about how to file an Administrative Hearing with DMAP. You must make the hearing request within 120 days from the date of the Notice of Appeal Resolution Letter. If you file a hearing request with DMAP, they will schedule the hearing within 45 days of the date of your request. At the hearing you can explain why you don’t agree with the decision. You can tell the judge why the services your provider requested should be covered. If you believe that your health condition cannot wait for a regular hearing you can ask DMAP for a fast (expedited) one. You should include a statement from your provider about how your health could be harmed by waiting for the regular hearing process. If DMAP agrees that it is urgent, they will contact you within 72 hours.
Neither DMAP or Health Share will pay for the cost of a lawyer. You may be able to get legal help here:
- Call the Public Benefits Hotline (a program of Legal Aid Services of Oregon and the Oregon Law Center) at 1-800-520-5292 for advice and possible representation. TYY/TDD users can dial 711.
- Legal aid information can also be found at www.oregonlawhelp.org
Below are links to the forms and information you will need for filing an appeal and/or administrative hearing. If you need help with filing, you can contact Health Share at 503-416-8090 or 1-888-519-3845. TTY/TDD users can call 711. Health Share Customer Service staff will help you with the process.