What to do if you have a grievance (complaint)
If you have a problem or complaint, we want to know. You can call us, write or send us a fax. Also, you can submit a complaint yourself, or you can have your authorized representative do it for you.
- Call Customer Service: 503-416-4279 or toll-free 888-712-3258 (TTY 711). C 1 октября по 31 марта мы работаем семь дней в неделю с 8 a.m. до 8 p.m., а с 1 апреля по 30 сентября мы открыты с понедельника по пятницу с 8 a.m. до 8 p.m. If there's anything else you need to do, Customer Service will let you know.
- Fax: Our fax number is 503-416-1313
- Write: To send your complaint by mail, our address is:
CareOregon Advantage
315 SW Fifth Ave
Portland, OR 97204
Complaints about quality of care
When your complaint is about quality of care, you have two extra options:
- You can make your complaint directly to the Quality Improvement Organization. The Quality Improvement Organization is a group of practicing doctors and other health care experts paid by the federal government to check and improve the care given to Medicare patients.
In Oregon, this organization is Acentra Health.
You can reach them by phone, toll-free at 888-305-6759 (TTY 711), Monday through Friday from 9 a.m. to 5 p.m., weekends and holidays from 10 a.m. to 4 p.m.
Or, you can send a written complaint to 5201 West Kennedy Blvd., Suite 900, Tampa FL 33609. - You can make your complaint to both the Quality Improvement Organization and us at the same time.
What happens after a complaint is sent
Receiving your complaint
Once we receive your complaint, it will be reviewed by a Grievance Coordinator who will send a letter of acknowledgement to you within five
business days.
We must address your complaint as quickly as your case requires based on your health status, but no later than 30 days after receiving your complaint. We may extend the timeframe by up to 14 days if you ask for the extension, or if we justify a need for additional information and the delay is in your best interest.
The deadline for making a complaint is 60 calendar days from the time you had the problem you want to complain about.
If you are making a complaint because we denied your request for a "fast coverage decision" or a "fast appeal," you have the right to file a "fast complaint." When you file a "fast complaint," it means we will give you an answer within 24 hours.
We look into your complaint and give you our answer
If possible, we'll answer you right away. If you call us with a complaint, we may be able to give you an answer on the same phone call.
Most complaints are answered within 30 calendar days. If we need more information and the delay is in your best interest or if you ask for more time, we can take up to 14 more calendar days (44 calendar days total) to answer your complaint. If we decide to take extra days, we'll tell you in writing.
If you're making a complaint because we denied your request for a fast coverage decision or a fast appeal, we'll automatically give you a fast complaint. If you have a fast complaint, it means we'll give you an answer within 24 hours.
If we don’t agree with some or all of your complaint or don’t take responsibility for the problem you’re complaining about, we’ll include our reasons in our response to you.
What to do if you have a problem with CareOregon Advantage
You can also tell Medicare about your complaint
You can submit a complaint about CareOregon Advantage Plus directly to Medicare. To submit a complaint to Medicare, go to www.Medicare.gov/my/medicare-complaint. You can also call 800-MEDICARE (800-633-4227). TTY/TDD users call 877-486-2048.
