Welcome to Yamhill
Community Care!

We are a group of all types of healthcare providers who work together for people on the Oregon Health Plan (OHP) in Yamhill County and parts of Polk and Washington Counties.

Get Started!

Your first step is to choose or change your Primary Care Provider (PCP) and dentist for your family. YCCO will automatically sign you up for a primary care provider when you enroll, but you have the right to stay with that provider or choose a different one. Even if you’re not sick now, you need to choose a PCP.  Call them first whenever you need care, they are your partners for good health.

• If you don’t have a PCP, use our Provider Search to find someone who is taking new patients, then call to tell us who you have chosen.
• Need help finding a PCP? Just give us a call, we can help!
  Customer Service 1-855-722-8205
• Review your member handbook for more info about you OHP  coverage. 

Learn about Language Access with this helpful video!

Are you a new member who needs service right away?

Members who are new to the OHP or YCCO may need prescriptions, supplies, or other items or services as soon as possible.

If you can’t see your primary care provider (PCP) or primary care dentist (PCD) in your first 30 days with YCCO:  

• While you are waiting for an appointment, you can call Care Coordination at 833-257-2191. They can help you get the care you need. Care coordination can help OHP members with Medicare, too. See the Care Coordination section in the member handbook (page 32) to learn more.
• If you are becoming a new Medicare enrollee, see the Members with OHP and Medicare section (page 83) in the member handbook for more information.
• Make an appointment with your PCP as soon as you can. You can find their name and number on your YCCO ID card.

Call Customer Service at 855-722-8205 if you have questions and want to learn about your benefits. They can help you with what you need.

Call us if you need help with

• Choosing or changing your primary care provider
• Your plan benefits and how to use them
• Finding a YCCO specialty provider
• Getting approval for medical services or supplies or where to get them
• Prescription drugs or help getting your prescribed medicine
• Prenatal (before birth) care and participating prenatal care providers
• What to do if you get a bill from a provider or hospital
• Care management or other health related services

You can call Customer Service at 855-722-8205 (TTY 711) for help, you can also email us at info@yamhillcco.org.  

Other types of support

We want you to get the best health care. Sometimes that means you might need help getting your needs met locally. If you face issues like being homeless, hunger, or have several health conditions, we can connect you with help.

Visit our Community Health Hub to learn more!

Talk to us, we’re listening

You want the best possible care. That’s our goal, too. Questions? Concerns? Compliments? Give us a call. 1-855-722-8205 Or send us an email at info@yamhillcco.org. We’re here to help any way we can.

Complaints?

YCCO and our providers want you to get the best care possible. 

What is a complaint? 

• A complaint is letting us know you are not satisfied.

• A dispute is when you do not agree with YCCO or a provider.

• A grievance is a complaint you can make if you are not happy with YCCO, your healthcare services, or your provider. A dispute can also be a grievance.

To make it easy, OHP uses the word complaint for grievances and disputes, too.  

You have a right to make a complaint if you are not satisfied with any part of your care. We will try to make things better. Just call Customer Service at 855-722-8205, TTY 711 or our Complaint Department at 833-257-2192 (TTY 711). If you need help in your language, just tell them. You can also make a complaint with OHA or Ombuds. You can reach OHA at 1-800-273-0557 or Ombuds at 1-877-642-0450. 

If you want to put your complaint in writing you can mail, email, or fax us a letter. You do not have to use the YCCO complaint form, you can also use the OHP form.

Send your letter, email, or form the way you want to here is our contact info: 

• Fax: 503-765-9675
• Mail: Yamhill Community Care
• Attn: Grievance Specialist
  P.O. Box 5490
  Salem, OR 97304
• Email: complaints@yamhillcco.org

*You may have personal info in your email put “secure” in the subject line so your info is protected.

Examples of reasons you may file a complaint are: 

• Problems making appointments or getting a ride 

• Problems finding a provider near where you live 

• Not feeling respected or understood by providers, provider staff, drivers or YCCO  

• Care you were not sure about, but got anyway 

• Bills for services you did not agree to pay 

• Disputes on YCCO extension proposals to make approval decisions 

• Driver or vehicle safety 

• Quality of the service you received  

A representative or your provider may make (file) a complaint on your behalf, with your written permission to do so. 

How long does the complaint process take?
We will look into your complaint and let you know what can be done as quickly as your health requires. This will be done within 5 business days from the day we got your complaint. 

If we need more time, we will send you a letter within 5 business days. We will tell you why we need more time. We will only ask for more time if it’s in your best interest. All letters will be written in your preferred language. We will send you a letter within 30 days of when we received the complaint explaining how we will handle it.  

What if I don’t like the results of my complaint?

If you are unhappy with how we handled your complaint, you can share that with OHP Client Services Unit at 1-800-273-0557 or please reach out to the OHA Ombuds Program. The Ombuds are advocates for OHP members and they will do their best to help you. Please email OHA.OmbudsOffice@odhsoha.oregon.gov or leave a message at 877-642-0450. 

Another resource for supports and services in your community is 211 Info. Call 2-1-1 or go to the www.211info.org website for help. 

Appeals

If you disagree with our decision, you have the right to ask us to change it. This is called an appeal because you are appealing our decision.  

If we deny, stop, or reduce a medical, dental, or behavioral health service, we will send you a denial letter that tells you about our decision. This denial letter is also called a Notice of Adverse Benefit Determination (NOABD). We will also let your provider know about our decision.

You have to get a denial letter before you can ask for an appeal.  

Providers should not deny a service. They have to ask YCCO if you can get approval for a service. 

If your provider says that you cannot have a service or that you will have to pay for a service, you can ask us for a denial letter (NOABD). Once you have the denial letter, you can ask for an appeal. 

You or someone with written permission to speak for you. That could be your doctor or an authorized representative can ask for an appeal.  You must ask no  more than 60 days from the date on the NOABD letter.

Reasons you may file an appeal:

• You asked to be paid for mileage for non-emergent medical appointments and you were denied
• We denied, stopped, or limited a medical, dental, or behavioral health service.
• You were denied a request for a non-emergent medical transportation service

How to appeal a decision
You can ask for an appeal orally or in writing. Ask us for an appeal by:

• Calling Customer Service at 855-722-8205 (TTY 711) or our Appeal Department at 833-257-2192 (TTY 711).
• Writing us a letter.
• Emailing us at appeals@yamhillcco.org  
• Filling out an Appeal and Hearing Request form number OHP 3302- it is sent with your NOABD letter. You can also get one here.
  • OHA 3302 Appeal and Hearing Request (English)
  • OHA 3302 Appeal and Hearing Request (Spanish)

You can mail, fax, or email  your letter or form to:

• Fax: 503-765-9675
• Emailing us at appeals@yamhillcco.org
• Mail: Yamhill Community Care Attn: Appeals & Grievance Specialist
  P.O. Box 5490
  Salem, OR 97304

If you want help with your appeal, call Customer Service and we can fill out an appeal form for you to sign.

You can ask your authorized representative, a certified community health worker, peer wellness specialist, or personal health navigator to help you. You may also call the Public Benefits Hotline at 800-520-5292 for legal advice and help.

 After I file my appeal what happens? 

Once we get your request, we will look at the original decision. A new doctor will look at your medical records and the service request to see if we followed the rules correctly. You can give us any more information you think would help us review the decision. 

To support your appeal, you have the right to: 

• Give information and testimony in person or in writing. 

• Make legal and factual arguments in person or in writing. 

 You must do these things within appeal timeframes listed below. 

How long do you get to review my appeal?
 We have 16 days to review your request and reply. If we need more time, we will send you a letter. We have up to 14 more days to reply.  

What if I need a faster reply?
You can ask for a fast appeal. This is also called an expedited appeal. Ask for a fast appeal if waiting for the regular appeal could put your life, health or ability to function in danger. Call us at 833-257-2192 or fax the request form to 503-765-9675. The form will be sent with the denial letter. You can also get it at https://bit.ly/request2review.  We will call you and send you a letter, within 1 business day, to let you know we have received your request for a fast appeal. 

How long does a fast appeal take?
If you get a fast appeal, we will make our decision as quickly as your health requires, no more than 72 hours from when the fast appeal request was received. We will do our best to reach you and your provider by phone to let you know our decision. You will also get a letter.  

 At your request or if we need more time, we may extend the timeframe for up to 14 days. 

If a fast appeal is denied or more time is needed, we will call you and you will receive written notice within two days. A denied fast appeal request will become a standard appeal and needs to be resolved in 16 days or possibly be extended 14 more days. 

If you don’t agree with a decision to extend the appeal time frame or if a fast appeal is denied, you have the right to file a complaint.  

We will send you a letter with our appeal decision. This appeal decision letter is also called a Notice of Appeal Resolution (NOAR). If you agree with the decision, you do not have to do anything. 

Still don’t agree? Ask for a hearing. 

You have the right to ask the state to review the appeal decision. This is called asking for a hearing. You must ask for a hearing within 120 days of the date of the appeal decision letter (NOAR).  

What if I need a faster hearing?
You can ask for a fast hearing. This is also called an expedited hearing. 

Use the online hearing form at https://bit.ly/ohp-hearing-form to ask for a normal hearing or a faster hearing.  

You can also call the state at 800-273-0557 (TTY 711) or use the request form that will be sent with the letter. Get the form at https://bit.ly/request2review. You can send the form to: 

• OHA Medical Hearings
  500 Summer St NE E49
  Salem, OR 97301    
• Fax: 503-945-6035 

The state will decide if you can have a fast hearing 2 working days after getting your request. 

Who can ask for a hearing?
You or someone with written permission to speak for you. That could be your doctor or an authorized representative.  

What happens at a hearing?
At the hearing, you can tell the Oregon Administrative Law judge why you do not agree with our decision about your appeal. The judge will make the final decision. 

YCCO Compliance & Ethics Hotline:

Providers may also report potential fraud, waste, and abuse to YCCO directly. YCCO has an anonymous Compliance & Ethics Hotline available 24/7 in which anyone may leave a voicemail message. This voice mailbox is monitored daily. If you would like to make a report anonymously, you may call toll free (844) 989-2845.

Do you need to make an anonymous report for a violation stated in the Yamhill Community Care Code of Conduct? You can file your anonymous report through Ethics Point by clicking here. 

Are You Pregnant?

It is very important for your health and your baby’s health to get maternity care while you are pregnant.

As soon as you know you are pregnant:

• Call OHP Customer Service at 800-699-9075. They will make sure you do not lose your benefits while you are pregnant. They can also help you get any other services that you may need.
• Call your PCP and set up a visit for prenatal care. If you prefer, you can pick your own obstetrician/prenatal care provider.
• We also have a team of care coordinators who can help support you physically and mentally during your pregnancy. Call  Customer Service 1-855-722-8205 and they will get you in touch with a YCCO staff member who is specially trained to meet your needs. 
• If you don’t already have a doctor (obstetrician) for care during your pregnancy, use the Provider Search to find one. Need help finding an obstetrician? Just give us a call.

Make sure that you have a PCP for your personal health care as well, visit the Provider Search or give us a call to find a PCP for your own health needs.

Your medications and diabetic supplies

If you take any regular medications, talk to your PCP about what’s covered in your plan.

• You can also visit our Pharmacy + Drug List page for more drug coverage information.
• If you’re diabetic, tell your PCP about the supplies you need.
• To find medical supplies or equipment, or set up mail order for your diabetic supplies, use our Provider Search to find a vendor.
• Or call us with any questions. 1-855-722-8205
• To learn more about your Pharmacy and Prescription Drug Benefits, please take a look at the 2025 Member Handbook (page 71).

As a new member, if you have trouble filling a prescription for your regular medication or getting diabetic supplies, call us. We may be able to help with supplies during your start up with YCCO.

Can’t make it to your doctor’s appointment? Make sure to give them a call ahead of time, your provider’s office will help to set up a new visit.

Need a ride to your health appointments? Visit our Transportation page to learn about our WellRide transportation service, or  call YCCO WellRide at 844-256-5720 for ride information.

Help improve the health of your community!

Lend your voice, become a council member. The Community Advisory Council (CAC) is made up of people like you who care about our community. You understand what it’s like to be an OHP member.

YCCO members, caregivers, YCCO staff, community members, and people from other local programs serve on the Council. CAC welcomes all ages, genders, orientations, languages, races and abilities. If you want to be part of the council, please contact us. We want to hear from you!

Contact the CAC Chair
Questions? Contact us!

Meetings:

Third Tuesday of each month
5:30 to 7:30 p.m.
Online (Please send a request to attend the CAC if you would like the login information)

Your input is welcomed! Contact us to attend a meeting or just share your feedback.

 Request to attend meeting