Your Rights as an Oregon Health Plan (OHP) Member

OHP Rights and Responsibilities

These rules list the rights and responsibilities you have as an OHP member:

410-120-1855 – For all OHP members.
410-141-3590 – For all OHP members in coordinated care organization (CCO).
410-141-3810 – Explains when members can ask for disenrollment from a CCO, and how to do this.

Your Rights

Be treated with dignity and respect, the same as other patients
Choose your health care providers
Tell your provider about all your health concerns
Have a friend or helper come to your appointments
Get an interpreter if you want one
Get information on all your covered and noncovered treatment options
Help make decisions about your health care, including refusing treatment
Not have people hold you down or keep you away from others as a way to:

Make you do something you don’t want to do
Make caring for you easier for your providers
Punish you for something you said or did

A referral or second opinion, if you need it
Get care when you need it, any time of day or night
Behavioral health (mental health and substance use disorder treatment) and family planning services without a referral
Help with addiction to cigarettes, alcohol and drugs without a referral
Get handbooks and letters you can understand
See and get a copy of your health records, unless your doctor thinks it would be bad for you
Limit who can see your health records
A Notice of Adverse Benefit Determination if you are denied a service or your service level changes
Information and help to appeal CCO denials and/or ask for a hearing
Make complaints and get a response without bad treatment from your plan or provider
Free help from the OHA Ombuds Program

OHP must respect the dignity and the diversity of all members and their the communities. By law, OHA and all its providers and plans must treat everyone fairly. To learn more, visit OHA's Civil Rights page .

Everyone has a right to learn about Oregon Health Authority (OHA) programs and services. They have the right to learn in a way they can understand.

Tell OHA, your CCO, dental plan and health care providers about your language needs.

You can ask for an interpreter at health care appointments. Tell your provider about this at least two days before the appointment.
You can ask OHA, your CCO/plans, health care providers and pharmacies to give you written information in a different language.
When you call, you can also ask to speak with someone who speaks your language.

OHP providers must offer and give you these services free of charge. If they don't, you can file a complaint.

To tell OHA your preferred written and spoken languages:

Call Oregon Eligibility (ONE) Customer Service at 800-699-9075, or
Log into your ONE account (go to Settings>Communication Preferences).

OHA can then share this information with your CCO/plans.

To tell your health care providers:

You can carry a preferred language card to show your providers at health care visits.

In Oregon, providers are required to use qualified and certified interpreters listed in Oregon's Health Care Interpreter Registry.

To learn more, visit the Language Access page.

There are times when people under age 18 (minors) may want or need to get health care services on their own. To learn more, read “Minor Rights: Access and Consent to Health Care." This booklet tells you the types of services minors can get on their own and how minors' health care information may be shared

Minor Rights and Access to Care (English) (Spanish). This guide tells you:

The types of services minors can get on their own, and
How their health information may be shared.

Under the Americans with Disabilities Act (ADA) providers must give people with disabilities full and equal access to health care services and facilities. People with disabilities have a right to reasonable changes to gain equal access.

To gain full and equal access, people with disabilities have a right to reasonable changes (called “accommodations”).

You can ask for an accommodation from OHA or your CCO.
For help with this, contact OHA’s Equity and Inclusion Division at OHA.PublicCivilRights@odhsoha.oregon.gov or 844-882-7889 (TTY 711).

OHP members who are American Indians or Alaska Natives can get their care from a tribal wellness center, Indian Health Services (IHS) clinic or the Native American Rehabilitation Association of the Northwest (NARA). This is true even if they are in a CCO.

A law, the Health Insurance Portability and Accountability Act (HIPAA), protects your health care records and keeps them private. This is also called “confidentiality.” A paper called “Notice of Privacy Practices” explains OHP members’ rights to keep their personal information private and how their personal information is used.

To get a copy, call your CCO and ask for its “Notice of Privacy Practices.”
If you are not in a CCO, you can find this notice online. You can also call OHP Client Services and ask for the “Notice of Privacy Practices.

You have the right to ask for copies of your health care records. You can get a copy of the following records:

Medical records from your doctor
Dental records from your dentist’s office
Records from your CCO.

Your providers and CCO may charge a reasonable fee for copies.

You can add something you think is missing from your records. You can also have a copy of your behavioral health records, except for parts your provider thinks could cause you harm to see or read.

You can ask your health care provider or CCO/plan for your records at any time.
You also have the right to make sure the information in your records is correct and know who has seen it.

Learn more on the OHP Patient Access to Health Care Records page.

Children and teens through age 20 have the right to health care that: