Insurance Incident Form
Oregon LAcs, this is form is to help the OAAOM gather useful provider complaints/experiences for our ongoing meetings with management at Regence Blue Cross Blu Shield, MODA and other groups. While you should always submit a complaint to the provider relations rep (and potentially the Oregon insurance division!) this form will help us gather complaints over time and provide accurate and useful data for reform of provider experience. Thanks for telling us your story!
Please list the insurance carrier or other relevant plan details here.
Please list the nature of the complaint(s). Check all that may apply.
Process issue with the website
Incorrect info given over the phone
Data lost due to unsavable form or computer glitch
Unclear policies or procedures provided by provider rep in an email or over the phone
Coverage was confirmed and treatment was preauthorized, but payment denied
Patient preauth denied even though they have benefits
Asked to refund payment after care was delivered and preauth approved
Coverage was confirmed and treatment was pre-authorized, but payment denied
Tell us any additional details about your story, especially a claim #, date of the incident or names of any reps you spoke with. DO NOT SHARE PATIENT IDENTIFIABLE INFORMATION.
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