Oregon: Start Here
Beginner guide for Oregon—HealthCare.gov, DFR external review, ORS 743B PA & appeals.
Read guideState playbook
Oregon
State insurers, legislation, and appeal resources for patients and advocates in Oregon.
4 guides
Oregon Prior Authorization Law
ORS 743B.420/423—2-day PA, binding approvals, HB 3134 surgical & API reforms.
Read guideOregon Health Insurance Appeals and Grievances
ORS 743B.250—180-day filing, 1–2 internal levels, deemed exhaustion, path to DFR IRO.
Read guideOregon External Review (DFR / IRO)
Binding on insurer—180 days to file, 30-day standard / 3-day expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Regence BlueCross BlueShield of Oregon
- Moda Health
- Providence Health Plan
- PacificSource Health Plans
- Kaiser Permanente Northwest
- BridgeSpan Health
- HealthCare.gov (Oregon)
- Oregon Health Plan / CCOs
External appeals
After internal appeal, for eligible Oregon fully insured plans only.
- DFR — external review
- OHP — administrative hearing