Painted Hills 1

 

Appeals

Asking Us to Reconsider a Decision 

We understand that you may disagree with a decision that we make. We make decisions about resolving complaints and we make decisions about authorizing coverage for care or treatment. When we make these decisions, we make every effort to avoid disagreements. If you do not agree with our decision, you may appeal. We will tell you about how to appeal decisions we make as part of the resolution process. This includes how to appeal our decisions that might have a negative impact on your coverage or benefits or our relationship. We will also help you with the appeal process. An appeal is your request for us to change our decision about a complaint resolution or coverage for care or treatment issue. You may request an administrative hearing to GOBHI or directly to Oregon’s Health Systems Division.   

When GOBHI makes decisions about complaints or authorizing coverage for care or treatment, we will tell you about how you can appeal the decision. If you are unhappy with the decision, you may file an appeal. Call, write, or fax us your appeal.  

Greater Oregon Behavioral Health, Inc.
Complaint and Appeals Coordinator
401 E. 3rd Street
Suite 101
The Dalles, OR 97058

Member Services: 1-800-493-0040
Fax Number: 541-298-7996

If you need language assistance to help you file an appeal, let us know. We will provide language assistance at no cost to you. We have bilingual staff and an interpreter service available for the entire process. Upon request, we can provide oral interpretation of documents written in English into your preferred language or translation of written documents into your preferred language. Finding the best way to resolve your appeal is an important part of our quality improvement program.  

We will investigate the issues thoroughly. The staff involved in the investigation will not be the same as the individual(s) who made the first decision. 

We propose resolutions to routine appeals within 16 calendar days and notify you of the decision. We propose resolutions to clinically urgent appeals within 72 hours and notify you of the decision.  

Appeal and Hearing Resources

Oregon Health Authority Division of Medical Assistance Programs Notice of Hearing Rights 

Oregon Department of Human Services Administrative Hearing Request Form

Oregon Health Authority Appeal and Hearing Request