How Do I …

If you are very unhappy with IHN-CCO, your health care services or your provider, you can complain or file a grievance with IHN-CCO. We will try to make things better.

To file a grievance, you can:

Call:
541-768-4550
800-832-4580
TTY 800-735-2900

Mail:
IHN-CCO Appeals and Grievances
PO Box 1310
Corvallis, OR 97339 

Fax:
541-768-9765 (Medical and Pharmacy Appeals)

Email:
[email protected]

File in person:
2300 NW Walnut Blvd
Corvallis, OR 97330

We can help you write or call in your complaint.

Your doctor or an authorized representative can make a complaint or file a grievance for you. You must give them written permission to do this.

If we can’t solve it in five (5) workdays, we will send you a letter to explain we need more time. We have up to 30 days to address your complaint or grievance. We will not tell anyone, who does not need to know, about your complaint or grievance unless you ask us to.

You can also complain to the Oregon Health Authority.

Call: Client Services
800-273-0557 (TTY 711)

Mail your complaint to:
Oregon Health Plan Client Services
PO Box 14520
Salem, Oregon 97309

File online: Oregon Health Plan Complaint Form

If we deny, stop, or reduce a service your provider has ordered, we will mail you a Notice of Action Benefit Denial letter explaining why we made that decision. You have a right to ask to change it through an appeal and a hearing through the state. You must first ask for an appeal no more than 60 days from the date on the Notice of Action Benefit Denial letter.

If you need a fast appeal:

If you or your provider believe that you have an urgent medical, dental, or mental health, pharmacy, or vision problem that cannot wait for a regular appeal, tell us that you need a fast (expedited) appeal. We suggest that you include a statement from your provider or ask them to call us and explain why it is urgent. If we agree that it is urgent we will call you with a decision in 72 hours (three (3) days).

How do I request an appeal?

In an appeal, a different health care professional at IHN-CCO will review your case. To ask for an appeal, you can:

• Call: 541-768-4500, 800-832-4582 (TTY 800-735-2900)
• Email: [email protected]
• Mail:
  IHN-CCO Appeals and Grievances
  PO Box 1310
  Corvallis, OR 97339 
• Fax: 541-768-9765 (Medical and Pharmacy Appeals)
• Fill out an Appeal and Hearing Request form (OHP form number 3302)
• File in person:
  2300 NW Walnut Blvd.
  Corvallis, OR 97330

After our review of an appeal you have filed with us, if you are still not happy with the outcome you are able to fill out an Appeal and Hearing Request with the state. This form is OHP number 3302, and ask the state to review.

If you want help with this, call and we can fill out an appeal form for you to sign. You can ask someone like a friend or case manager to help you. You may also call the Public Benefits Hotline at 800-520-5292 for legal advice and help. You will get a Notice of Appeal Resolution from us in 16 days letting you know if the reviewer agrees or disagrees with our decision. If we need more time to do a review, we will send you a letter saying why we need up to 14 more days.

You can keep on getting a service that already started before our decision to stop it. You must ask us to continue the service within 10 days from the date of the Notice of Action Benefit Denial letter that stopped it. If you continue the service and the reviewer agrees with the original decision, you may have to pay the cost of the services that you received after the Effective Date on the Notice of Action letter.

Provider Appeals:

Your provider has a right to appeal for you when your physician’s orders are denied by a plan. You must give your provider written consent to appeal for you.

You can have a copy of your medical records. Your doctor or dentist have most of your records, so you can ask them for a copy.

They may charge a reasonable fee for copies. You have the right to request changes or corrections to your medical records. You can ask us for a copy of the records we have. We will not charge you a fee for the copies.

You can have a copy of your mental health records unless your provider thinks this could cause serious problems.

If you still disagree with the appeal decision from us, you, your provider, or an authorized representative can ask for a hearing with an Oregon Administrative Law Judge. You will have 120 days from the date on your Notice of Appeal Resolution (NOAR) to ask the state for a hearing. Your NOAR letter will have an Appeal and Hearing Request form that you can send in. You can also ask us to send you an Administrative Hearing Request form, or call OHP Client Services at 800-273-0557 (TTY 711), and ask for form number 3302.

At the hearing, you can tell the judge why you do not agree with our decision and why the services should be covered. You do not need a lawyer, but you can have one or someone else, like your doctor, with you. If you hire a lawyer you must pay their fees. You can ask the Public Benefits Hotline (a program of Legal Aid Services of Oregon and the Oregon Law Center) at 800-520-5292 (TTY 711), for advice and possible representation. Information on free Legal Aid can also be found at oregonlawhelp.org.

A hearing takes more than 30 days to prepare. While you wait for your hearing, you can keep on getting a service that already started before our original Notice of Action decision to stop it. You must ask us to continue the service within 10 days of getting the Notice of Appeal Resolution that confirmed our denial. If you continue the service and the judge agrees with the original decision, you may have to pay the cost of the services that you received after the date on the Notice of Appeal Resolution.

Fast (Expedited) Hearing

If you and your provider believe that you have an urgent health problem that cannot wait for a regular hearing process, say that you need a fast (expedited) hearing and fax the Hearing Request form to the OHP Hearings Unit. We suggest that you include a statement from your provider explaining why it is urgent. You should get a decision in two (2) working days. The Hearings Unit’s fax number is 503-945-6035.

Completing an Advance Directive

You can get an Advance Directive form at most hospitals and from many providers. You also can download an advance directive form from OregonHealthCare.gov. If you write an Advance Directive, be sure to talk to your providers and your family about it and give them copies. They can only follow your instructions if they have them. Learn more about Advance Directives and find helpful resource information.

Under Oregon law, you have the right to create an advance directive. You also have the right to decide your own health care as long as you are able to — even if you have an advance directive. You can change your mind or cancel your advance directive at anytime.   

You can view our policy on Advance Directives here.

If your provider does not follow your wishes in your Advance Directive, you can complain. Complete the OHA Complaint Intake Form.

Send your complaint to:

• Health Care Regulation and Quality Improvement
  800 NE Oregon St, #465
  Portland, OR 97232
• Email: [email protected]
• Fax: 971-673-0556
• Phone: 971-673-0540 (TTY 971-673-0372)

You can have this document in another language, large print, Braille, CD, on tape, or another format, please contact us. Here is the Member Handbook (Spanish)if you would like to read or print it. If you want us to send you a Member Handbook, please contact us.

You can have a free voice or sign language interpreter at your appointments if you want one. When you call for an appointment, tell your provider’s office that you need an interpreter and for which language. Information on Health Care Interpreters is at Oregon.gov/oha/oei.

Your IHN-CCO ID card will tell you what type of coverage you have. Below is a sample of what your ID card looks like. The area circled above is important to know what benefits you have with IHN-CCO. The following categories are available:

• Med/Rx means medical and pharmacy coverage.
• BH means behavioral health coverage.
• Dental means dental coverage.

Under each area there will be either a “Y” or a “N”. If there is a “Y” than IHN-CCO provides this for you. You may have only one type of coverage with IHN-CCO or you may have all your health coverage with IHN-CCO.

Call your Primary Care Provider (PCP), Primary Care Dentist (PCD) or mental health provider. See information in the following sections about getting a PCP, PCD or mental health provider if you do not already have one.

Here are some helpful tips when making an appointment with your PCP, PCD, Dental Plan and Mental Health providers:

• Tell the provider’s office you are an IHN-CCO member.
• Give them your name, ID number, and a phone number where you can be reached, so your provider can contact you when needed.
• Make sure to say how soon you need to go in.  If you think your medical needs are urgent, tell the office and explain why.
• If you need an interpreter for your visit, make sure you tell the receptionist what language you speak at least 3 days before the appointment. You also can call IHN CCO at 541-768-4550, toll-free 800-832-4580, or TTY 800-735-2900.
• You can also ask your provider’s office about their ADA accessibility if you use a wheelchair or walker.
• Make separate appointments for each of your family members.

Before Your Appointment

What to take with you:

• Always bring your IHN-CCO medical ID card and Oregon Health ID card.
• A friend or family member: another person who can help listen for important details during your appointment.
• A list with: Questions you have about your health or treatment. Medicines you are taking at this time.
• If you are not able to be at your appointment for any reason, call your provider’s office as soon as you can to cancel or change the appointment.

At Your Appointment

• Be on time.
• Relax: do not be nervous, take slow, deep breaths.
• Ask your health care provider the following questions:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do this?
• Get the answers you need. If you do not understand something, ask to have it repeated or explained.
• Write down information that will help you remember details of the visit. You can ask for a copy of the doctor’s instructions.

IHN-CCO provides services to members with exceptional needs. If you have questions, need more help, or want to get in touch with a Care Coordinator, please contact us.