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What Notice do MCOs in Oregon have to Provide for Denials?

14 Mar, 2025 Frank Ferreri

oregon 139402 640
                               
Compliance Corner

When a managed care organization in Oregon denies a service, what kind of notice does it have to send out? That answer -- and more -- is on Simply Research, but as a sneak peek, we cover it below.

The Rule

The MCO must send written notice of its decision to all parties that can appeal the decision. If the MCO provides a dispute resolution process for the issue, the notice must include the following, in bold text:

Notice to the worker and all other parties:

If you want to appeal this decision, you must:

- Notify us in writing within 30 days of the mailing date of this notice

- Send your written request for review to:

{MCO name} {MCO address}

If you have questions, contact {MCO contact person and phone number}.

If you do not notify us in writing within 30 days, you will lose all rights to appeal the decision, unless you show good cause. If you appeal within the 30-day timeframe, we will review the disputed decision and notify you of our final decision within 60 days of your request. After that, if you still disagree with our decision, you may appeal to the Department of Consumer and Business Services (DCBS) for further review. If you do not seek dispute resolution through us, you will lose your right to appeal to DCBS.

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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