Who should I call if I have any questions about filing a complaint?

You can contact the Oregon Division of Financial Regulation at (888) 877-4894. The Division is open from 8:00 a.m. to 5:00 p.m., Monday through Friday.

What happens after the Department receives my complaint?

Once you have filed your complaint, you will be notified that your complaint has been received and assigned to an advocate.[15] The advocate will send a copy of your complaint to your health insurer for a response. Your health insurer has...

How do I file a complaint?

If you are an Oregon resident and your claim is denied after the external review process, you can file a complaint with the Division. Complaint information. Your complaint should include the following information: The name, address, email address, and telephone number...

How long will the external review process take?

The external review process should take no more than 30 days after you apply to the insurance company for external review.[10] If you requested an expedited external review, the process should take no more than three days after your request is...

How do I request an external review?

You should submit your request for external review to your health insurer, which will forward your request to the Division of Financial Regulation (“Division”).[6] The Division will then randomly assign your case to an external review organization.[7] You must file your...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Oregon law, you are entitled to request an external...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days.[2]

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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