Health Insurance

Parents tell us...

nurse with mom and baby

"Why is this so complicated?!" "I had no idea Oregon had a department to help solve insurance issues." " My teen turns 18 soon. How can I keep him on our insurance?" "I was so confused but with help we got it figured out." "Welcome to my other part-time job: Insurance Appeals Expert."

Where to get insurance I How does insurance work   Help with insurance and care coordination  I Appeal a denial  I Double coverage

Where to get insurance

You may be able to privately purchase an insurance plan for your child from your employer, directly from insurance companies, agents, brokers, or online health insurance sellers.

The Oregon Health Authority website lists other places you may find a plan for your child. They also provide insurance assisters and trained community partners to help you find a plan and/or see if your child qualifies for a subsidized plan.

If your child qualifies for Developmental Disability services, she may be eligible for the Oregon Health Plan as secondary coverage. Speak to your child's case manager about this.

Don't have insurance? Try:

HRSA Health Centers (also called Community Health Centers) care for you, even if you have no health insurance. Some health centers also provide mental health, substance abuse, oral health, and/or vision services.

School Based Health Centers offer health care for the whole family.

Community health fairs may offer free screenings or care on a first come, first served basis. Contact your county health department, dial 211 toll free, text your zip code to 898211, or and ask about upcoming health fairs.

Other ideas: 

Employee Assistance Programs (EAP): Contact your human resources department to see if they offer free or reduced-cost mental health services for their employees.

Many hospitals and clinics offer discounts, so before any procedure, ask for a financial screening to see if you qualify, even if you doubt you will. 

See  tip sheet When Insurance Won't Pay.

Explore Financial Help.

How does insurance work?

Insurance is complicated but necessary for you to understand. We have provided some great resources to learn the basics, but if you need to find an expert to help you with a specific insurance concern, call us at 855-323-6744.

Consumer Reports: Understanding health insurance 

HealthCare.gov:

FROM COVERAGE TO CARE

What is a Summary of Benefits

Comparing Insurance Plans

Re-enrolling or Changing Insurance In the Middle of the Year

Family Voices: Insurance Jargon 

Who can help me coordinate with my insurance plan and care?

If your child has OHP and requires a lot of providers, medications, or appointments, you may be eligible for help coordinating that care from an Exceptional Needs Care Coordinator, Intensive Care Manager, or Community Health Worker. You can also ask for Family Peer Support Worker, who is a trained family member and will understand what you are going through. See our tip sheet for instructions on how to request care coordination help.

Some plans that are not OHP, may also provide help. Call the number on your child's insurance card and ask if there is someone on her plan.

What if I need to appeal a denial?

Patient Advocate Foundation: A Patient's Guide to Navigating the Insurance Appeals Process

First call your insurance company Customer Service Line. Sometimes wait times can be long so put your phone on speaker. Be persistent, have the denied claim in front of you when you speak to someone, and write or record what you are told.

If that does not work, there is help.You must know the type of plan your child has, as this determines who will be able to help you with the appeals process. 

Plans fall into three categories:

  • Oregon Health Plans
  • Group plan
  • Self-insured plans

If your employer pays for it, you probably have a "group plan".  If you work for a big company that buys their own insurance, it may be called a "self-insured plan". You can find out which type you have by asking the human resources department at your company. Some resources for help are below.  Call us if you need more help 855-323-6744 (English) or 503-931-8930 (Spanish). 

If you have a "Group Plan", you can get help from the Oregon DCBS Division of Financial Regulation at 1-888-877-4894 (toll-free) or e-mail cp.ins@state.or.us.

If you have a "Self-Insured" plan, you can get help from Large Group Plan Online Assistance or call 206-757-6632.

If your child's plan is from the Oregon Health plan you have several places to get help:

  1. Call your ICM/ENCC.
  2. Call the Department of Financial Regulation
  3. Contact the Governor's Advocacy Office 

Double coverage

Many families have children with two insurance plans. For example, children who receive Developmental Disability (DD) services may have OHP, and a policy through their parents' work, as well. Or, if both parents have insurance through their work, the child may be on both plans. Double coverage is good, but can get confusing. In general, whenever there are two policies, the private insurance pays their part first and then OHP pays second. If you have two private insurance plans, it is important to let your providers know and find out which one pays first and which one pays second.

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