Appeals & Complaints
Complaints
YCCO and our providers want you to get the best care possible. 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.
- 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.
You can also complain to the Oregon Health Authority. Call Client Services at 800-273-0557 (TTY 711), or sent your complaint to:
Oregon Health Plan Client Services
P.O. Box 14520
Salem, Oregon 97309
You may also find a complaint form here: https://apps.state.or.us/Forms/Served/he3001.pdf
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.
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.
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 211info.org 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.
- 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
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 (denial) letter. You can also get one from OHA.
- OHP 3302 Appeal and Hearing Request
- OHP 3302 Solicitud de apelación y audiencia
- OHP 3302 طلب الاستئناف وجلسة الاستماع
- OHP 3302 Racfaanka iyo Codsiga Maqalka
- OHP 3302 Апелляция и ходатайство о проведении слушания
- OHP 3302 Yêu cầu kháng cáo và điều trần
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.
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.
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.
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.
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.
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).
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.
You or someone with written permission to speak for you. That could be your doctor or an authorized representative.
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.