These are your rights as a health plan member.
These are your responsibilities as a health plan member.
When you receive care from providers in the network, they will process your claims directly with us, so you don't need to handle any paperwork. However, if you receive care from a non-network provider, you may have to pay the provider for the service and then file a claim with us for reimbursement.
To file a claim for reimbursement, simply follow these steps:
Please see your Benefit Booklet for more details on filing claims.
If you disagree with how a claim was paid ─ as described on your Explanation of Benefits (EOB) ─ you can request a review. We must receive your request to review a claim within 180 days after you receive your EOB. You can either call Customer Service or submit a written request. If you suspect that payments were made for services you didn't receive - please call the Anti-Fraud Hotline at 800-596-3440.
If you prefer, you can submit a written request so you can make a copy for your records. Along with your written request, include a copy of your EOB to identify details of the disputed claim and any other documents or information that may help resolve your claim to your satisfaction. After we receive your request, we'll send you detailed information about our appeals process, including the timeframes for each step of the process. Send your request to:
LifeWise Health Plan or Oregon
P.O. Box 91059
Seattle, WA 98111-9159
Questions? Concerns? Please contact Customer Service.
Please note: Some groups may have a different contact phone number. Please confirm your contact number on the back of your ID card before calling. For more detailed information about your benefits, see your contract or Contact Us.
You can make complaints about:
You also have the right to appeal any action we take or decision we make about your coverage or services.
Learn what an Explanation of Benefits (EOB) is and how to read it.