Benefits overview

Your Member ID card offers information about the health plans that provide your coverage. See the image below for a guide to your card.

Contact Oregon Health Authority:

• For information about enrollment, including renewals, your application status, changing your CCO and name/address changes.

The Oregon Health Authority (OHA) runs the Medicaid program for the entire state of Oregon, which is called the Oregon Health Plan (OHP).

Online: one.oregon.gov

Phone: Toll-free 800-699-9075 or TTY 711, 8 a.m. to 5 p.m. Monday-Friday

 

Contact Health Share of Oregon:

• To replace a lost or stolen Member ID card.
• To make a health plan or dental plan change within Health Share.

Health Share is a coordinated care organization (CCO). It’s one of two CCOs that work under OHA to serve OHP members in the tri-county area.

Online: healthshareoregon.org

Phone: 503-416-8090, toll-free 888-519-3845 or TTY 711, 8 a.m. to 5 p.m. Monday-Friday

Email: info@healthshareoregon.org

 

Contact CareOregon:

• To change your PCP or find a provider.
• For questions about your benefits and eligibility, such as:
• Is my coverage active?
• What medications or services are covered?
• What’s the status of my appeal or prior authorization?
• For help navigating a question or problem, or want to submit a complaint.

CareOregon is one of several insurance providers in the tri-county area that helps Health Share deliver care to OHP members.

Phone: 503-416-4100, toll-free 800-224-4840, TTY 711, 8 a.m. to 5 p.m. Monday-Friday

Email: customerservice@careoregon.org 

Secure message: careoregon.org/portal

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CareOregon takes fraud, waste and abuse very seriously. If you suspect that your benefits aren't being used correctly or want to report a case of fraud, waste or abuse, please contact Ethics Point at 888-331-6524. You also can file a report online at ethicspoint.com.

How to make a complaint or grievance

If you are unhappy with CareOregon or Health Share of Oregon, your health care services or your provider, you can complain or file a grievance at any time, for anything other than a denial of service. Your provider or authorized representative may also file a grievance on your behalf with your written consent.

We will try to make things better. Just call Customer Service t 503-416-1460 or toll-free at 888-519-3845, or send us a letter to the address on page 73 of your member handbook, available on the Health Share of Oregon website.

CareOregon and Health Share of Oregon will work to resolve your complaint or grievance as quickly as your health condition requires. If we need more than five business days, we will send you a letter to let you know why. You will receive a final answer within 30 calendar days. We will not tell anyone about your complaint unless you ask us to.

You can also file a complaint with:
Oregon Health Authority (OHA)
Please call the OHP Client Services unit (CSU) toll free at 800-273-0557 or OHA’s Ombudsman at 503-947-2346 or toll free at 877-642-0450. 

Appeals and hearings

If we deny, stop or reduce a medical service your provider has ordered, we will mail you a Notice of Action letter explaining why we made that decision. You have a right to ask to change it through an appeal and a state fair hearing. You must ask for an appeal no more than 60 days from the date on the Notice of Action letter. You can ask for a denial notice that shows a service is not covered if:

• You did not receive a written notice of denial, or;
• Your provider tells you that you will need to pay for a service that is not covered.

For full instructions on the appeals process, please see page 71 of your member handbook, available on the Health Share of Oregon website.

Provider Appeals

Your provider has a right to appeal for you when their physician’s orders are denied by a plan. You must agree to this in writing. Instructions for this process can be found on page 72 of your member handbook, available on the Health Share of Oregon website.

 

Download one of the forms below to manage your personal information.

• Member protected health information (PHI) release request form
• Member protected health information (PHI) release request form (Spanish)
• Member request to view claim records form

CareOregon manages services for several plans throughout the state. Use the following links to find the Member Resources for the plan you are assigned to:

Q: Will CareOregon ever send me a bill?

A: No. We will never charge you for any covered Medicaid/OHP service.

 

Q: Will I owe a copayment if I go to the doctor?

A: Our members are not charged copayments or fees when they see a doctor or other provider in our network. There may be a copayment at pharmacies for certain mental health prescriptions that are covered by the state.

If a medical office asks you for a copayment, ask the staff to call Customer Service.

When you make an appointment, let the office know you’re covered by CareOregon.

 

Q: What should I do if a doctor’s office mails me a bill?

A: You probably don’t owe anything for covered services while you are a CareOregon member. Call CareOregon Customer Service right away to find out.

 

Q: I need to see a doctor, but I don’t have my Health Share of Oregon Member ID card yet. What should I do?

A: Call Customer Service. We’re happy to help.

 

Q: I lost my Member ID card. How do I get a new one?

A: Call Health Share of Oregon Customer Service toll-free at 888-519-3845 or TTY 711, 8 a.m. to 5 p.m. Monday-Friday.