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Ask Us to Review a Health Care Decision (Request a Hearing)

Have you been denied a medical service or benefit? You have a right to ask for a review of the decision. This is called asking for a hearing. Use this form to help you ask for a hearing. Asking for a hearing doesn't change your OHP.

This form is for Oregon Health Plan member hearing requests ONLY.  Provider appeals should be directed to the appropriate CCO. 

Free help is available. Go to:

Here are two things you can do at any time, in addition to asking for a hearing. They will not give you more time to ask for a hearing, so you will need to do them right away:

  • You can ask your doctor about other ways to treat your condition.
  • You can ask for the information used to make this decision:
    • CCO members: Call the Customer Service number for your CCO plan. Click here to look up your CCO’s contact information.
    • If you are not in a CCO: Call OHP Client Services at 1-800-273-0557.

Before the hearing, an OHA staff member will call you to ask you for more information and answer your questions.

At the hearing, you can say why you do not agree with the decision. Most hearings are on the phone. These people will also be there:

  • An OHA hearings representative
  • A representative from the clinical unit or CCO that made the decision
  • Your representative or helper (if you have one)
  • An administrative law judge
  • Any witnesses you invite

After the hearing, the judge will review the information from the hearing and make a decision. You will get a “Proposed and Final Order” (the judge’s decision) within 30 days. Hearings follow the Administrative Procedures Act, Oregon Revised Statute (ORS) Chapter 183, and Oregon Administrative Rules 137-003-0501 to 0700, 410-120-1860, 410-141-3900.

If you have a hearing and the service is still denied, you can choose to pay for the denied service yourself. Ask your provider about this. You and your provider must then sign an “Agreement to Pay” to show that you understand you must pay for the non-covered service.

For denials of CCO services: For denials of CCO services: OHA must get your request within 120 days of the date shown on the “Notice of Appeal Resolution” (the letter you got about the appeal).

For denials of DHS/OHA services: OHA must get your request within 60 days of the date shown on the “Notice of Denial” (the letter you got about the service denial).

If you ask after this deadline, you must show that you had a good reason for being late.

If your request is late or if you do not ask for a hearing:

  • For denials of CCO services: You may lose your right to a hearing on the decision. If this happens, the most recent decision notice will be the final decision (or “final order by default”). It will become effective 120 days after the date of the notice. You will not get other notices about the decision. The record for the final order is the case file used to make the decision, with any materials you give later about it.
  • For denials of DHS/OHA services: You may lose your right to a hearing on the decision. If this happens, the most recent decision notice will be the final decision (or “final order by default”). It will become effective 60 days after the date of the notice. You will not get other notices about the decision. The record for the final order is the case file used to make the decision, with any materials you give later about it.
  • If you cancel your hearing request or miss your hearing, you will get a dismissal order. You may still appeal the dismissal under ORS 183.482 by filing a petition in the Oregon Court of Appeals. You must do this within 60 days of the date of the dismissal order. The dismissal order will tell you the deadline.

Note to military personnel: The federal Servicemembers Civil Relief Act gives active duty members the right to delay these proceedings. To learn more, you may contact the Oregon State Bar at 800-452-8260, the Oregon Military Department at 503-584-3571 or an Armed Forces legal assistance office, http://legalassistance.law.af.mil.

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Please send your filled form to OHA Medical Hearings at OHAMedical.Hearings@dhsoha.state.or.us.

Start here:

The text will appear here

CCOs are local health plans that help you use OHP. You can find the CCO in your area here.

To see if you are a CCO or FFS member, call OHP Client Services.

OHP Client Services can be reached at 1-800-273-0557. Once you know if you are a CCO member or a Fee for Service (FFS) member, please try again. Click the "Restart" button below to start over.

You must ask your CCO plan to review the decision before a hearing can move forward. This is called requesting an appeal. If you do not agree with the appeal decision from your CCO plan, you can ask the Oregon Health Plan to decide if it was fair. This is called asking for a hearing.

CCOs are local health plans that help you use OHP. You can find the CCO in your area here.

You can ask for a hearing from OHP.

You must complete an appeal with your CCO before requesting a hearing.

You must ask your CCO plan to review the decision before a hearing can move forward. This is called requesting an appeal. After your CCO plan makes a decision, you can ask the Oregon Health Plan to review that decision in a hearing. Please call your CCO and ask for an appeal. You can find your CCO plan's contact information here. If you need help, please call OHP Client Services at 800-273-0557 (TTY 711).

Ask your CCO for help.

Tell your CCO about the denial and ask if you can appeal the decision. You can find your CCO plan's contact information here.

3. Tell us about the member who received the denial:

Starred fields are required.

You can find this number on your Oregon Health ID from OHA, your CCO member ID card or Notice of Denial.

The law allows the Oregon Health Authority to ask for your Social Security number (SSN). You can find these laws under 42 USC 1320b-7(a) and (b), 7 USC 2011-2036, 42 CFR 436.920, and 42 CFR 457.340(b). You are not required to give an SSN. If you do, OHA will use it only to help locate your file and records.

A “Reasonable accommodation” is help DHS/OHA provides so you can participate in the meeting. An example of a reasonable accommodation would be having an interpreter present during the hearing phone call.

You can also ask about reasonable accommodations when a hearings representative calls you.

You may have a friend, family member, advocate, doctor or lawyer help at the hearing. List their contact information below or tell the OHA hearing representative when they call you.

If you want a lawyer to help at the hearing, you can call here for help:

  • Public Benefits Hotline at 800-520-5292 for advice and possible representation. Legal Aid Services of Oregon and the Oregon Law Center provide this hotline.
  • Oregon State Bar at 800-452-8260 about free or low-cost legal services.

You can ask for a friend, family member, advocate, doctor or lawyer to help at the hearing. If you don’t have one now, you can add a representative at any time before the hearing. If you want a lawyer, you can ask for help from:

• Public Benefits Hotline at 800-520-5292 (TTY 711), for advice and possible representation. Legal Aid Services of Oregon and the Oregon Law Center provide this hotline.

• Oregon State Bar at 800-452-8260, to learn about free or low-cost legal services.

If you want someone to represent you at the hearing, give us their contact information on this form or tell the OHA hearing representative when they call you.

If yes, tell us about the member's helper:

Please share the following information so that we can ask this person if they agree to be your helper: 

If you are not the member or the member's helper, tell us about yourself:

4. Tell us about the request

You should get a letter with the decision about your appeal from your CCO plan. This letter is called a Notice of Appeal Resolution.

You should get a letter with the decision about your appeal from OHA or DHS. This letter is called a Notice of Denial.

CCO members: OHA must get your request within 120 days of the “Date of Notice” or “effective date” on the “Notice of Appeal Resolution” (the letter you got from your CCO about the appeal).

FFS members: OHA must get your request within 60 days of the “Date of Notice” or “effective date” on the “Notice of Denial” (the letter you got from OHP).

If you ask after this deadline, you must show that you had a good reason for being late.

    Tap or click the "Attach" button to choose files to upload. You can upload a photo (JPG, TIFF or PNG), use your camera to take a picture, or attach a PDF or a Word file (.DOC) from your files (up to 10 mb each).

    If you were getting the service before the CCO or plan denied it, you can ask to keep getting it while you wait for your hearing. To do this, you must:

    • Check “Yes” to this question and the subquestion that appears AND

    • Ask for the hearing no later than 10 days after the “Date of Notice” or “effective date” of the notice, whichever is later.

    If the hearing does not change the decision, you may have to pay for services you get on or after the effective date of the notice.

    Please note: If the hearing does not change the decision, you may have to pay for services you get on or after the effective date of the notice.

      Tap or click the "Attach" button to choose files to upload. You can upload a photo (JPG, TIFF or PNG), use your camera to take a picture, or attach a PDF or a Word file (.DOC) from your files (up to 10 mb each).

      Sign and submit

      Please give us your email address below. We will send a confirmation email and a copy of your completed request form to this address.

      Enter the email address where you wish correspondence related to this request to be delivered.

      Re-enter the email address wher you wish correspondence related to this request to be delivered.

      OHP 3302 | Version 2.34 | Updated 06/20/23