Your Voice Matters
At Umpqua Health, we want to hear from you. If you are not happy with a decision or service, you can file a grievance (complaint), an appeal, or request a hearing. This will not affect your health coverage, your provider, or how you are treated.
You, your provider, or someone you trust can speak up for you. If someone else helps you, we will need your written permission. We will review your concerns, keep them private, and do our best to find a solution.
Need More Information?
We can help you with this process at no cost to you. This can include:
- Help understanding the process or filling out forms
- A care coordinator or community health worker
- Interpreter services
- Letters in other languages or formats
We can give you more information about how we handle grievances and appeals. We can also provide a copy of any forms or policies.
Grievance (Complaints)
Not Happy With Your Care?
If you are not satisfied with the care you received, you can file a complaint. This is called a grievance. You can file a grievance for things like:
- Being treated without respect
- Poor quality of care
- Other problems that are not about a denied service
*Note: If your concern is about a denied service, you may need to file an appeal instead.
File a Complaint Now
If something didn’t go right with your care or services, you can file a complaint at any time. Here’s how you can do it:
- Call us during business hours at 541-229-4842
- Email your Complaint Form to UHAGrievance@umpquahealth.com
- Mail It In – Send your completed Complaint Form to:
Umpqua Health Alliance
Attn: Grievance and Appeals
3031 NE Stephens St
Roseburg, OR 97470
Grievance FAQs
- We gather the facts. We may ask you for more information and reach out to others involved.
- We try to resolve it fast! We will respond within 5 business days whenever possible.
- More time may be needed. If we need extra time or more information, we will send you a letter. We’ll then give you an answer within 30 days.
- We’ll contact you. You’ll get the resolution by phone and mail.
Dental issues are handled by your Dental Care Organization (DCO).
For help, contact Advantage Dental at 866-268-9631.
Appeals
Denied, Stopped, or Reduced Services?
If we deny, stop, or reduce a service your provider requested, you’ll get a Notice of Adverse Benefit Determination (NOABD). This explains why and is not a bill. Your provider will also be notified. If you disagree, you have the right to request an appeal within 60 days.
How to Appeal
If you disagree with our decision, you have 60 days from the date on the denial notice to ask for an appeal. You, your provider, or a representative (with written permission) can request one. You can request an appeal in one of the following ways:
- Call us during business hours at 541-229-4842 or toll free at 866-672-1551
- TTY: 711 (541-440-6304)
- In Writing: Complete the Request to Review a Healthcare Decision form (OHP 3302) included with your denial notice. Return it to us by mail or fax using the contact information provided on the form.
- Mail:
Grievance and Appeals
3031 NE Stephens Street
Roseburg, OR 97470 - Fax: 541-677-5880
- Mail:
Appeals FAQs
We will review your case. A different doctor will look at your records and our decision. You can send in more information if you think it will help. We’ll send you a Notice of Appeal Resolution once the review is done, along with a hearing request form if you still disagree.
- Standard appeals: We decide within 16 days after receiving your request
- Extensions: We may take up to 14 extra days if needed, and you’ll get a letter explaining why
- Grievance rights: You can file a grievance if you disagree with the extension
You or your provider can ask for a fast appeal if waiting could harm your health.
- We will decide within 72 hours
- We’ll try to notify you and your provider by phone
- You’ll always get a written notice
- Extensions of up to 14 days are possible, with a letter explaining why
Requesting a State Hearing
If you disagree with our appeal decision or we did not meet the required timeframes to make a decision, you have the right to request a state hearing. A hearing is your chance to explain your case to an Oregon Administrative Law Judge, who will make the final decision.
Your provider or someone you trust can also request the hearing for you, as long as you give written permission.
You have 120 days from the date on your Notice of Appeal Resolution to ask for a hearing.
Submit the Request to Review a Healthcare Decision form (OHP 3302) to:
OHA – Medical Hearings Unit
500 Summer St NE, E49
Salem, OR 97301
Fax: 503-945-6035
If waiting for a standard hearing could seriously harm your health, you may request a fast (expedited) hearing. Be sure to check that box on the OHP 3302 form.
The Oregon Health Authority will review your request. If it’s denied, you will receive a letter within two business days.
You can represent yourself or choose someone to help you—like a friend, family member, doctor, or lawyer. If you hire an attorney, you are responsible for their fees.
For free legal advice or help:
- Call the Public Benefits Hotline at 1-800-520-5292 (TTY 711)
- Visit www.OregonLawHelp.org
Help If Your Care is Denied or Interrupted
If a service or benefit you were already receiving is reduced or stopped, you can ask to keep receiving it during the appeal process. You must request this within 10 days of the denial notice or appeal resolution letter. If the decision is not overturned, you may have to pay for the services you received. If the decision is reversed, we will either cover past services or approve the benefit quickly, within 72 hours of the reversal.
Your provider may also request a peer to peer review with our Medical Director to discuss the denial. This is separate from the appeal process and does not replace your right to file an appeal.