How do appeals work?
If you received a letter denying a service, you may appeal your denial. We send information about the appeal process with a denial letter. If you no longer have that information, please click on the links under Appeal Forms to get copies of the paperwork you will need.
- Use the information given to you in your denial to submit an appeal
- Submit your appeal within 45 days of your notice
- With your permission your doctor can help you appeal
- Notice of Action to Deny, Reduce or Stop a Benefit »
- Third Page of Denial Letter »
- Administrative Hearing Request »
How to file a grievance:
Tuality Health Alliance (THA) accepts grievances on behalf of all of our members regarding patient care, providers, staff, or the health plan. You may file a grievance over the phone, in writing, or through the Contact THA section of our website.
THA strives for excellent customer service and patient care for our members and takes all grievances seriously. We document every grievance received and submit each one through our grievance review process. Each grievance is handled on an individual basis, but all grievances received are monitored for patterns and trends.
THA attempts to resolve a grievance within 5 working days, but some grievances take more time and attention. If needed, a grievance can be extended to being resolved up to 30 days. We will always notify you of this extension and why it’s needed. THA will respond with the resolution of your grievance within the same manner as it was received, i.e. over the phone or in writing.
You can file a grievance by:
Phone: 503-844-8104 (Monday through Friday, 8 a.m. to 5 p.m.)
Mail: Tuality Health Alliance
Attn: grievances and Grievances Dept.
PO Box 925
Hillsboro, OR 97123
Online submission: Online grievance (https://tualityhealthalliance.org/contact/)
What information will we share?
- Healthcare information with providers for treatment
- Billing information
- Healthcare information on your behalf for health management
What if I need more information shared?
If you want to give us permission to share your information with another agency or person, please fill out our “Authorization for Use and Disclosure of Information” form. If you would like more information on our privacy practices please read our “Notice of Privacy Practices” form.
Release of Information Form and Privacy Practices
Who do I call with questions?
Tuality Health Alliance member service line is open Monday-Friday from 8am-5pm to answer questions you may have.
- 503-844-8104 or 1-866-575-8104
- TTY 1-800-735-2900