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Sat Dec 1, 2018, 03:40 PM

Oregon Health Plan MAJOR problems-wrongful denial.

My wife & I have 2 children & we have been properly covered through the OHP.

We recently mailed in a renewal form including copies of income etc. I'm on disability & they had a statement for that. My wife works retail & we easily qualify.

We recieved a denial letter stating that they had not recieved anything.

Ok so I call. I stayed on hold for 165 minutes!!. This was just before Thanksgiving so I did as much baking & preparation as I could & finally spoke to a human.

They said hmmm never got the renewal. Told her when it was mailed & said I'd repeat everything just do not cut us off.

Here's where I get suspicious. They had the renewal right there they just found it what a coincidence.

But oh my there is another piece of information needed that I didin't have. She said she would try to look it up on SSDI records & verify. I also got a e-mail adress to send the document.

My wife came home & had the exact document she needed. I e-mailed a quality legible photo of the entire document.

The OHP person called that night while my wife was there. I figured she had gotten my e-mail.

Nope-she said she just couldn't find the info on SSDI and oh well she tried. I said I just e-mailed you those documents. She refused to acnowledge it and I again stated they could not go without coverage it would make my family very at risk.

I thought I had & I did do everything asked to keep the coverage.

Today my wife tried to get her prescritions filled & was denied. They have ended coverage.

So here I go again. On hold Monday for however long it takes & I am pissed beyond measure.

Any advice?

Call a TV help program? Shame them somehow?

They were obviously determined to deny my family coverage it was qualified for-I really would like some answers.

But this is just so wrong and frustrating. Windmills are easier to fight!.


5 replies, 921 views

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Reply Oregon Health Plan MAJOR problems-wrongful denial. (Original post)
Boxerfan Dec 2018 OP
spooky3 Dec 2018 #1
torius Dec 2018 #2
vsrazdem Dec 2018 #3
vsrazdem Dec 2018 #4
Boxerfan Dec 2018 #5

Response to Boxerfan (Original post)

Sat Dec 1, 2018, 04:22 PM

1. I know it's expensive, but I would use certified mail

to send everything to them again. Request a signature showing receipt and track the delivery online.

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Response to Boxerfan (Original post)

Sat Dec 1, 2018, 04:28 PM

2. I think states have an insurance commissioner

I think states have an insurance commissioner that you can file a complaint with. What they did was a typical tactic to deny coverage.

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Response to Boxerfan (Original post)

Sat Dec 1, 2018, 04:38 PM

3. Do they have a facebook page or twitter account.

They hate having people post this type of thing to the public. I am sure you would get a response from them.

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Response to Boxerfan (Original post)

Sat Dec 1, 2018, 04:45 PM

4. Also, file a formal complaint with the State Insurance Commissioner office.

There are some steps to go through to file a formal complaint. When I did it I had to use their forms, but that was before the internet was much more user friendly. As soon as the states starts investigating, you will get a call from your insurance company Pronto.

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Response to Boxerfan (Original post)

Mon Dec 3, 2018, 05:35 PM

5. UPDATE!. We are covered again-it was them not me....

And it only took 120 minutes on hold this time. This time somebody competent who wanted to help. I had already supplied all the documentation she needed after a quick review we were done.

I had to ask "Why?". It was so uneccesary & a pain in the ass. Oh we have a lot of new employee's was the response.

Thats just great a freeper working at OHP.

At least were good for another year.

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