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 complaint:
Tuality Health Alliance (THA) accepts complaints on behalf of all of our members regarding patient care, providers, staff, or the health plan. You may file a complaint 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 complaints seriously. We document every complaint received and submit each one through our complaint review process. Each complaint is handled on an individual basis, but all complaints received are monitored for patterns and trends.
THA attempts to resolve a complaint within 5 working days, but some complaints take more time and attention. If needed, a complaint 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 complaint within the same manner as it was received, i.e. over the phone or in writing.
You can file a complaint by:
Phone: 503-844-8104 (Monday through Friday, 8 a.m. to 5 p.m.)
Mail: Tuality Health Alliance
Attn: Complaints and Grievances Dept.
PO Box 925
Hillsboro, OR 97123
Online submission: Online Complaint (http://www.tuality.org/tha/index.php/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.
Disclosure 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