CONSUMER INSURANCE

Your rights as an insurance consumer:

According to Oregon Law, your insurance carrier must contract with a sufficient number of accessible providers so that you receive treatment without unreasonable delay ( ORS 743B.505).  If you are finding it difficult to find a provider that accepts your private insurance (for OHP, scroll down), COPACT recommends that you report this to the DCBS insurance division. The complaint form is online (or can be printed) and only takes a few minutes to complete:
Click here to access the online complaint form
  • It is only necessary to complete the required field, marked with a red "*".
  • Click here to see a sample form and verbiage.
  • Though a response to your complaint may be slow, it is very important that the DCBS be informed of any violations as this is the only means to hold insurance providers accountable. 
Click here to print the PDF complaint form
Additional Consumer Rights:​
  • ​Insurers must provide fair claim settlement practices, including: promptly providing an explanation for the denial of a claim, promptly replying to all communication related to claims, conducting a reasonable investigation before denying a claim, not delaying investigations or payment of claims, and not misrepresenting facts or policy provisions in regard to claims ( ORS 746.230(1)(m))
  • ​No statements may be made in any form which are untrue, deceptive or misleading ( ORS 746.110)
  • Mental health and substance use treatment must be comparable to physical health treatment. This means that co-payments, deductibles, yearly visit limits, need for prior authorization, proof of medical necessity and access to care must equal that which is offered for physical health services ( MHPAEA)
  • Insurers must provide information about the criteria it uses to decide if treatment is medically necessary ( MHPAEA)
  • Insurance companies cannot place a dollar limit on how much they will cover over your lifetime. For plans sold or renewed on or after Jan. 1, 2014, federal law prohibits annual dollar limits on coverage of essential benefits ( MHPAEA)
  • Insurers must acknowledge nonemergency complaints and appeals within seven days and must make a decision and respond within 30 days ( DCBS)
  • If your insurance company rejects your first appeal and your plan is through an employer, you may have the right to a second appeal ( DCBS)
  • If your insurance company rejects all appeals, you have the right to an independent external review  by a third party unaffiliated with your insurer ( DCBS)
To learn more about your rights as an insurance consumer, visit the 
Deparment of Consumer and Business Services (DCBS) website  

If you have additional questions, email DCBS directly at:
[email protected] or call: 888-877-4894
​​For questions or complaints related to the Oregon Health Plan contact the following:
  • 1-800-273-0557 or EMAIL: [email protected]
  • OHA Ombudsperson: EMAIL: [email protected], PHONE: 877-642-0450
  • Legal Aid Services of Oregon and Oregon Law Center - Public Benefits Hotline: 800-520-5292
  • OHA Behavioral Health Administrative Rule Book ( PDF)