Umpqua Health Alliance (UHA) cares about you and your health. If you need help or have a complaint about any part of your care, you can let us know. We will not punish you or take away your coverage if you tell us your concerns. We will not punish your provider. We will make sure that all involved do not receive anything in return for the outcomes. UHA will be sure to find a solution as fast as we can to be sure it doesn’t affect your health. Our team will look into each of your concerns and keep it private.
A grievance is when you are not happy with your care, but not because of a denied service. This could be for the quality of care you received, if your rights were not respected, if you had a bad experience with office staff, etc. You can:
**Please note that dental grievances are handled by your Dental Care Organization (DCO). Please contact Advantage Dental at 866-268-9631 for more information**
We will work to resolve your complaint within five (5) business days. If you, your providers, or UHA needs more time and it benefits you, more time can be added by request. If this is the case, UHA will tell you in writing if more time is needed. We will work to resolve the issue in no longer than 30 days.
If you don’t like our answer, you can file a complaint with the Oregon Health Authority (OHA) Ombudsperson. They can be reached at (503) 947-2346, or toll- free at (877) 642-0450. The TTY number is 711. Their fax number is (503) 947-2341.
An appeal is when you disagree with a denied service or payment. We will have sent you and your provider a letter explaining the denial. This letter is called a “Notice of Action”. You will need to file the appeal in writing with UHA no later than 60 days from the date on the denial letter we sent you. This is done by filling out the Hearing Request and Information form sent to you with your denial notice. You can also call Customer Care and start the appeal process. You will still need to send in the signed form for UHA to move forward. If you need another form, you can call Customer Care and ask for one to be mailed to you. For more information on this process, click here.
**Standard appeal timelines will apply unless you or your provider feel that waiting will affect your life, health, or ability to attain, maintain, or regain maximum function. If this is the case you may qualify for an expedited (or fast) appeal.**
When we reach a decision on your appeal we will send you a letter called a “Notice of Appeal Resolution” (NOAR). If we agree with your appeal, we will approve and pay for the service. If we do not, this letter will tell you why. We will also send you information on how to ask for a state fair hearing.
You must finish the appeal process before requesting a state fair hearing with Oregon Health Authority (OHA). We tell you how to do this when you get your decision of the appeal letter, also called the “Notice of Appeal Resolution” (NOAR). If your appeal was not in your favor, you can ask for a hearing within 120 calendar days from the date of the NOAR. You have the right to have an attorney or member representative present, and availability of free legal help through Legal Aid Services and Oregon Law Center, including the telephone number of the Public Benefits Hotline 1-800-520-5292, TTY711.
Phone: Customer Care (M-F; 8AM – 5PM) 541-229-4842/Toll Free: 866-672-1551/ TTY: 541-440-6304
UHA A & G
500 Cass Ave., Suite 101
Roseburg, OR 97470