Health insurance or Medicaid said no in Oregon? Deadlines and free help

In Oregon, your health plan is regulated by Oregon Division of Financial Regulation (DFR), Department of Consumer and Business Services, if it is a state-regulated plan.

Oregon runs its own independent review of denials: External Review (independent review organization). You generally have 180 days to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Medicaid / Oregon Health Plan (OHP)

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov (Oregon Health Insurance Marketplace)) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Oregon?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
180 days
Hearing deadline
60 days for services, 90 days for eligibility
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – HealthCare.gov (Oregon Health Insurance Marketplace)
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

If you bought insurance yourself or get it from an employer that does business only in Oregon, contact the Division of Financial Regulation. If your job-based coverage is from a self-insured employer (often a large company or one with locations in several states), contact the U.S. Department of Labor's Employee Benefits Security Administration.

Step 1: Appeal to your plan in Oregon

What it is called: Internal appeal (grievance)

Your insurer must acknowledge a non-emergency complaint or appeal within 7 days and decide within 30 days, and must have a faster (expedited) process for urgent cases. Job-based group plans may have up to two levels of internal appeal; individual plans and drug formulary exception denials have one level. You can keep getting an approved, ongoing course of treatment while the internal appeal is pending, and you can get copies of the documents about your denial free of charge. If the insurer does not strictly follow the appeal rules, you are treated as having finished the internal appeal and can go to external review.

Law: ORS 743B.250(2)

All the details →

Step 2: Outside review in Oregon

External Review (independent review organization)

Deadline to ask: 180 days.

All the details →

Urgent care in Oregon: faster decisions

Outside review

The review is expedited if the denial is about an admission, continued stay or service after emergency care and you have not been discharged, or if a provider who treats you certifies in writing, with supporting documents, that the normal time could seriously jeopardize your life or health or your ability to regain maximum function. Expedited reviews are decided within 3 days.

Law: ORS 743B.252, 743B.255, 743B.256, 743B.257, 743B.258

Standard: 30 days; Urgent: 3 days

Medicaid

Use the online hearing form, or fax form OHP 3302 to 503-945-6035, and include a statement from your provider explaining why it is urgent. If OHA agrees, the Hearings Unit calls you within 72 hours.

Law: ODHS/OHA form MSC 0443

Complaints about your plan in Oregon

For other problems with an insurer, file a complaint with DFR online or contact a DFR consumer advocate at 1-888-877-4894 (503-378-4140 in Salem) or DFR.InsuranceHelp@dcbs.oregon.gov.

dfr.oregon.gov

Medicaid (Oregon Health Plan (OHP)) denials in Oregon

Who holds the hearing: OHA Medical Hearings unit (hearings held by an administrative law judge).

Hearing deadline: 60 days for services, 90 days for eligibility

All the details →

Marketplace decisions in Oregon

Oregon uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov (Oregon Health Insurance Marketplace)

1-855-231-1751

Other rights in Oregon

Reviewer can set aside the insurer's standards

The independent reviewer may override the insurer's standards for medically necessary or experimental treatment if it finds them unreasonable or inconsistent with sound medical practice.

Law: ORS 743B.256(2)

If the insurer does not send records

The insurer must send your records to the reviewer within 5 business days. If it does not do so on time, the reviewer may reverse the denial.

Law: ORS 743B.252(3)(a)

Diagnosis and treatment codes

On request, the insurer must give you the diagnosis and treatment codes, and their meanings, linked to a denial.

Law: ORS 743B.250(12)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Oregon and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Oregon

Good to know in Oregon

  • Oregon gives 180 days to ask for external review, longer than the federal 4 months.

    Law: ORS 743B.255(1)

  • Oregon external review decisions come within 30 days, or 3 days if expedited.

    Law: ORS 743B.256(3)-(4)

  • Oregon CCOs must decide Medicaid appeals within 16 days (OHA, OHP Appeals and Hearings).

Changes in 2024–2026

Senate Bill 972 (2023) requires the Oregon Health Authority to move the Oregon Health Insurance Marketplace off HealthCare.gov to its own state-based platform and call center by November 1, 2026, for plan year 2027 (OHA, State-based Marketplace Project). 2025 c.388 added public reporting of insurers' prior authorization approvals and denials.

Law: ORS 743B.250(8)

Questions about appeals in Oregon

How long do I have to appeal a health insurance denial in Oregon?

Oregon law does not set a longer deadline. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Oregon?

External Review (independent review organization). Send a written request for external review to your insurer, which must send it to DFR. DFR randomly assigns an independent review organization and mails you the case information. You can send extra information directly to the reviewer within 5 business days after you are told who was assigned.

Is outside review free in Oregon?

External review is free. The insurer pays all costs and may not charge you a fee.

How long do I have to ask for a Medicaid fair hearing in Oregon?

60 days for services, 90 days for eligibility. The date on the Notice of Denial from OHA, for a service or payment denial if you are not in a CCO. For a medical eligibility decision (denial or end of OHP coverage) you have 90 days from the date of the notice; after a CCO appeal you have 120 days from the date on the Notice of Appeal Resolution.

Can I keep my Medicaid benefits while I appeal in Oregon?

To keep a service you already get, ask your CCO or OHA to continue it at the same time you appeal or ask for a hearing. Form OHP 3302 says to ask no later than 10 days after the 'Date of Notice' shown on the notice; OHA's web page says within 10 days of the effective date on the notice.

Who regulates health insurance in Oregon?

Oregon Division of Financial Regulation (DFR), Department of Consumer and Business Services. If you bought insurance yourself or get it from an employer that does business only in Oregon, contact the Division of Financial Regulation. If your job-based coverage is from a self-insured employer (often a large company or one with locations in several states), contact the U.S. Department of Labor's Employee Benefits Security Administration.

Not about a denied claim?

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