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If you have questions or concerns about your benefits, the quality of care you receive, or how quickly and informally the claims administrators reached a decision or handled a claim, please contact Member Services. We may be able to resolve an issue quickly and informally.

Choose Your Plan to Review Your Member Rights

Filing a Grievance

You or your authorized representative can file your grievance verbally or, in writing. Within five (5) business days of receiving a grievance, we will send you or your authorized representative an acknowledgment letter. If the grievance cannot be resolved within five business days, we will notify you in writing that additional time is required. You or your authorized representative will then receive a written decision within 30 days from your initial call or letter.

You may receive information about our grievance and appeal processes from our Member Services Department at 541-768-4550; toll-free at 800-832-4580; TTY 800-735-2900; or you can contact us by the following:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOGrvcTeam@samhealth.org

Filing a Level 1 Appeal

You or your authorized representative may submit an appeal of an adverse benefit determination. The appeal request must be:

  1. in writing;
  2. signed;
  3. include the appeal reason; and
  4. received by us within 180 days of the denial or other action giving rise to the appeal.

You can use an Appeal Request Form available from Member Services to provide this information.

Within five (5) business days of receiving the appeal, we will send you or your authorized representative an acknowledgment letter. You or your authorized representative has the right to appear in person to talk about your appeal. The Level 1 appeal decision will be determined by a healthcare professional not previously involved in your initial adverse benefit determination. You or your authorized representative will receive a written decision within 30 days of our receiving your appeal request.

Please Note: If you, your authorized representative or your treating provider believes that the request to appeal is urgent (meaning, a review decision made within the standard timeframe of 30 days could seriously jeopardize your life or health or your ability to regain maximum function), your appeal will be processed in an expedited manner. For urgent appeals, your treating provider can act as your authorized representative.

If your request for appeal meets the definition of urgent, you or your authorized representative can request a simultaneous expedited External Review. For more information, please refer to Expedited Appeal Process below.

External Review

External Review decisions are made by Independent Review Organizations (IRO) that is not associated with Samaritan Health Plans. Your External Review appeal will be randomly assigned to an IRO by the Oregon Division of Financial Regulation.

Your appeal can qualify for an External Review (at no cost to you) if:

  • The plan does not adhere to the rules and guidelines of the process defined for the internal review
  • The Level 1 appeal has been completed and, the reason for the Level 1 adverse decision was:
    • based on medical necessity
    • for treatment determined to be experimental or investigational
    • for the purpose of continuity of care (no interruption of an active course of treatment); or
  • You and the plan have mutually agreed to waive the internal appeals requirement

We must receive your written request for an External Review within 180 days of the Level 1 adverse decision.

Please Note: When you send a request for External Review, you or your authorized representative must submit a signed waiver granting the IRO access to your medical records pertaining to the adverse decision. You can request the waiver form from the plan.

If your request meets the definition of urgent as defined by law, you or your authorized representative can request an expedited External Review. For more information, please refer to Expedited Appeal Process.

To apply for an External Review, you must send your written request or the Appeal Request Form to us:

By mail: Samaritan Health Plans – Appeals Team P.O. Box 1310 Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org

Once Samaritan Health Plans has been notified of the assigned IRO, we will submit your External Review request to the IRO within 5 business days. When you are notified by the IRO that your request for External Review has been received, you will have 5 business days to submit additional information about your appeal.

The IRO (Independent Review Organization) will return a written decision to you or your authorized representative and to the plan within the following timeframes:

  • Expedited External Review – 3 days after receipt of the request
  • Standard External Review – 30 days after receipt of the request

IRO decisions are final and we are bound by their decisions. If you want more information regarding External Review, please contact our Member Services Department at 541-768-4550; toll-free at 800-832-4580 or TTY 800-735-2900.

Expedited Review Process

If you believe your appeal is urgent, you, your authorized representative or your treating provider, can request an Expedited Review. If the appeal request meets the definition of urgent under the law; which means, a decision made within the standard timeframe of 30 days could seriously jeopardize your life or health or your ability to regain maximum function, the appeal will be processed in an expedited manner (within 3 days of our receiving the appeal request). If the appeal does not meet the definition of urgent, you will be notified immediately and the appeal will then be processed within the standard timeframe.

The Expedited Review request must:

  • be filed verbally or in writing within 180 days after you receive notice of the initial written pre-service denial;
  • state the reason for the appeal request;
  • state the reason an expedited decision is needed; and
  • include supporting documentation necessary to make a decision

When applicable, if you are simultaneously requesting an expedited External Review in addition to an expedited internal review, a signed waiver granting the IRO access to your medical records pertaining to the adverse decision must be included.

The internal Expedited Review decision will be determined by a healthcare professional not previously involved in your case. A verbal notice of the decision will be provided to you, your authorized representative and your treating provider as soon as possible, but no later than 3 days of our receiving the appeal. A written notice will be mailed within one working day following the verbal notification. If you have requested a simultaneous expedited External Review, Samaritan Health Plans will also forward your appeal to the IRO. Once the IRO has made a decision, Samaritan Health Plans is obligated to follow and honor the decision that was made by the IRO, regardless of the decision or opinions made by Samaritan Health Plans. If Samaritan Health Plans does not honor the decision made by the IRO, you or your authorized representative has the right to sue.

To apply for an Expedited Review:

Send your written request, or the Appeal Request Form, to:

By mail: Samaritan Health Plans – Appeals Team P.O. Box 1310 Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org
Or call our Member Services Department: 541-768-4550, toll-free 800-832-4580 or TTY 800-735-2900.

Appeal Timeframes

Samaritan Health Plans has the following timeframes for making internal review decisions on appeals:

  • 3 days for urgent appeals
  • 30 days for pre-service appeals
  • 30 days for post-service appeals

Filing a Grievance

You or your authorized representative can file your grievance verbally or, in writing. Within five (5) business days of receiving a grievance, we will send you or your authorized representative an acknowledgment letter. If the grievance cannot be resolved within five business days, we will notify you in writing that additional time is required. You or your authorized representative will then receive a written decision within 30 days from your initial call or letter.

You may receive information about our grievance and appeal processes from our Member Services Department at 541-768-4550; toll-free at 800-832-4580; TTY 800-735-2900; or you can contact us by the following:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org

Filing a Level 1 Appeal

You or your authorized representative may submit an appeal of an adverse benefit determination. The appeal request must be:

  1. in writing;
  2. signed;
  3. include the appeal reason; and
  4. received by us within 180 days of the denial or other action giving rise to the appeal.

You can use an Appeal Request Form available from Member Services to provide this information.

Within five (5) business days of receiving the appeal, we will send you or your authorized representative an acknowledgment letter. You or your authorized representative has the right to appear in person to talk about your appeal. The Level 1 appeal decision will be determined by a healthcare professional not previously involved in your initial adverse benefit determination. You or your authorized representative will receive a written decision within 30 days of our receiving your appeal request.

Please Note: If you, your authorized representative or your treating provider believes that the request to appeal is urgent (meaning, a review decision made within the standard timeframe of 30 days could seriously jeopardize your life or health or your ability to regain maximum function), your appeal will be processed in an expedited manner. For urgent appeals, your treating provider can act as your authorized representative.

If your request for appeal meets the definition of urgent, you or your authorized representative can request a simultaneous expedited External Review. For more information, please refer to Expedited Appeal Process below.

External Review

External Review decisions are made by Independent Review Organizations (IRO) that is not associated with Samaritan Health Plans. Your External Review appeal will be randomly assigned to an IRO by the Oregon Division of Financial Regulation.

Your appeal can qualify for an External Review (at no cost to you) if:

  • The plan does not adhere to the rules and guidelines of the process defined for the internal review
  • The Level 1 appeal has been completed; and, the reason for the Level 1 adverse decision was:
    • based on medical necessity
    • for treatment determined to be experimental or investigational
    • for the purpose of continuity of care (no interruption of an active course of treatment); or
  • You and the plan have mutually agreed to waive the internal appeals requirement

We must receive your written request for an External Review within 180 days of the Level 1 adverse decision.

Please note: When you send a request for External Review, you or your authorized representative must submit a signed waiver granting the IRO access to your medical records pertaining to the adverse decision. You can request the waiver form from the plan.

If your request meets the definition of urgent as defined by law, you or your authorized representative can request an expedited External Review. For more information, please refer to Expedited Appeal Process.

To apply for an External Review, you must send your written request or the Appeal Request Form to us:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org 

Once Samaritan Health Plans has been notified of the assigned IRO, we will submit your External Review request to the IRO within 5 business days. When you are notified by the IRO that your request for External Review has been received, you will have 5 business days to submit additional information about your appeal.

The IRO (Independent Review Organization) will return a written decision to you or your authorized representative and to the plan within the following timeframes:

  • Expedited External Review – 3 days after receipt of the request
  • Standard External Review - 30 days after receipt of the request 

IRO decisions are final and we are bound by their decisions. If you want more information regarding External Review, please contact our Member Services Department at 541-768-4550; toll-free at 800-832-4580 or TTY 800-735-2900.

Expedited Review Process

If you believe your appeal is urgent, you, your authorized representative or your treating provider, can request an Expedited Review. If the appeal request meets the definition of urgent under the law; which means, a decision made within the standard timeframe of 30 days could seriously jeopardize your life or health or your ability to regain maximum function, the appeal will be processed in an expedited manner (within 3 days of our receiving the appeal request). If the appeal does not meet the definition of urgent, you will be notified immediately and the appeal will then be processed within the standard timeframe.

The Expedited Review request must:

  • be filed verbally or in writing within 180 days after you receive notice of the initial written pre-service denial;
  • state the reason for the appeal request;
  • state the reason an expedited decision is needed; and
  • include supporting documentation necessary to make a decision

When applicable, if you are simultaneously requesting an expedited External Review in addition to an expedited internal review, a signed waiver granting the IRO access to your medical records pertaining to the adverse decision must be included.

The internal Expedited Review decision will be determined by a healthcare professional not previously involved in your case. A verbal notice of the decision will be provided to you, your authorized representative and your treating provider as soon as possible, but no later than 3 days of our receiving the appeal. A written notice will be mailed within one working day following the verbal notification.

If you have requested a simultaneous expedited External Review, Samaritan Health Plans will also forward your appeal to the IRO. Once the IRO has made a decision, Samaritan Health Plans is obligated to follow and honor the decision that was made by the IRO, regardless of the decision or opinions made by Samaritan Health Plans. If Samaritan Health Plans does not honor the decision made by the IRO, you or your authorized representative has the right to sue.

To apply for an Expedited Review:

Send your written request, or the Appeal Request Form, to:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org

Or call our Member Services Department: 541-768-4550, toll free 800-832-4580 or TTY 800-735-2900.

Appeal Timeframes

Samaritan Health Plans has the following timeframes for making internal review decisions on appeals:

  • 3 days for urgent appeals
  • 30 days for pre-service appeals
  • 30 days for post-service appeals

Filing a Grievance

You or your authorized representative can file your grievance verbally or, in writing. Within five (5) business days of receiving a grievance, we will send you or your authorized representative an acknowledgment letter. If the grievance cannot be resolved within five business days, we will notify you in writing that additional time is required. You or your authorized representative will then receive a written decision within 30 days from your initial call or letter.

You may receive information about our grievance and appeal processes from our Member Services Department at 541-768-4550; toll-free at 800-832-4580; TTY 800-735-2900; or you can contact us by the following:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org

Filing a Level 1 Appeal

You or your authorized representative may submit an appeal of an adverse benefit determination. The appeal request must be:

  1. in writing;
  2. signed;
  3. include the appeal reason; and
  4. received by us within 180 days of the denial or other action giving rise to the appeal.

You can use an Appeal Request Form available from Member Services to provide this information.

Within five (5) business days of receiving the appeal, we will send you or your authorized representative an acknowledgment letter. You or your authorized representative has the right to appear in person to talk about your appeal. The Level 1 appeal decision will be determined by a healthcare professional not previously involved in your initial adverse benefit determination. You or your authorized representative will receive a written decision within 30 days of our receiving your appeal request.

Please Note: If you, your authorized representative or your treating provider believes that the request to appeal is urgent (meaning, a review decision made within the standard timeframe of 30 days could seriously jeopardize your life or health or your ability to regain maximum function), your appeal will be processed in an expedited manner. For urgent appeals, your treating provider can act as your authorized representative.

If your request for appeal meets the definition of urgent, you or your authorized representative can request a simultaneous expedited External Review. For more information, please refer to Expedited Appeal Process below.

External Review

External Review decisions are made by Independent Review Organizations (IRO) that is not associated with Samaritan Health Plans. Your External Review appeal will be randomly assigned to an IRO by the Oregon Division of Financial Regulation.

Your appeal can qualify for an External Review (at no cost to you) if:

  • The plan does not adhere to the rules and guidelines of the process defined for the internal review
  • The Level 1 appeal has been completed; and, the reason for the Level 1 adverse decision was:
    • based on medical necessity
    • for treatment determined to be experimental or investigational
    • for the purpose of continuity of care (no interruption of an active course of treatment); or
  • You and the plan have mutually agreed to waive the internal appeals requirement

We must receive your written request for an External Review within 180 days of the Level 1 adverse decision.

Please note: When you send a request for External Review, you or your authorized representative must submit a signed waiver granting the IRO access to your medical records pertaining to the adverse decision. You can request the waiver form from the plan.

If your request meets the definition of urgent as defined by law, you or your authorized representative can request an expedited External Review. For more information, please refer to Expedited Appeal Process.

To apply for an External Review, you must send your written request or the Appeal Request Form to us:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org

Once Samaritan Health Plans has been notified of the assigned IRO, we will submit your External Review request to the IRO within 5 business days. When you are notified by the IRO that your request for External Review has been received, you will have 5 business days to submit additional information about your appeal.

The IRO (Independent Review Organization) will return a written decision to you or your authorized representative and to the plan within the following timeframes:

  • Expedited External Review – 3 days after receipt of the request
  • Standard External Review – 30 days after receipt of the request

IRO decisions are final and we are bound by their decisions. If you want more information regarding External Review, please contact our Member Services Department at 541-768-4550; toll-free at 800-832-4580 or TTY 800-735-2900.

Expedited Review Process

If you believe your appeal is urgent, you, your authorized representative or your treating provider, can request an Expedited Review. If the appeal request meets the definition of urgent under the law; which means, a decision made within the standard timeframe of 30 days could seriously jeopardize your life or health or your ability to regain maximum function, the appeal will be processed in an expedited manner (within 3 days of our receiving the appeal request). If the appeal does not meet the definition of urgent, you will be notified immediately and the appeal will then be processed within the standard timeframe.

The Expedited Review request must:

  • be filed verbally or in writing within 180 days after you receive notice of the initial written pre-service denial;
  • state the reason for the appeal request;
  • state the reason an expedited decision is needed; and
  • include supporting documentation necessary to make a decision

When applicable, if you are simultaneously requesting an expedited External Review in addition to an expedited internal review, a signed waiver granting the IRO access to your medical records pertaining to the adverse decision must be included.

The internal Expedited Review decision will be determined by a healthcare professional not previously involved in your case. A verbal notice of the decision will be provided to you, your authorized representative and your treating provider as soon as possible, but no later than 3 days of our receiving the appeal. A written notice will be mailed within one working day following the verbal notification.

If you have requested a simultaneous expedited External Review, Samaritan Health Plans will also forward your appeal to the IRO. Once the IRO has made a decision, Samaritan Health Plans is obligated to follow and honor the decision that was made by the IRO, regardless of the decision or opinions made by Samaritan Health Plans. If Samaritan Health Plans does not honor the decision made by the IRO, you or your authorized representative has the right to sue.

To apply for an Expedited Review:

Send your written request, or the Appeal Request Form, to:

By mail: Samaritan Health Plans – Appeals Team, P.O. Box 1310, Corvallis, Oregon 97339
By fax: 541-768-9765
By email: SHPOAppealsTeam@samhealth.org

Or call our Member Services Department: 541-768-4550, toll free 800-832-4580 or TTY 800-735-2900.

Appeal Timeframes

Samaritan Health Plans has the following timeframes for making internal review decisions on appeals:

  • 3 days for urgent appeals
  • 30 days for pre-service appeals
  • 30 days for post-service appeals