How to Resolve a Claim

How to Resolve a Medical, Vision or Dental Claim

Before contacting anyone, be ready to provide:

• ODS Member Number
• Claim Reference Number or
• Date of Service and Provider

To Resolve a Claims Issue

Call ODS Customer Service toll-free:

• For medical or vision claims, call (866) 923-0409.
• For prescription claims, call (866) 923-0411.
• For dental claims, call (866) 923-0410.

If Not Resolved...

• Administrative employees may contact the 4J Employee Benefits Manager at (541) 687-3479. 
• Classified employees may contact the Classified Benefits Coordinator at (541) 687-3248.
• Licensed employees may contact the Licensed Staff Benefits Coordinator at (541) 687-3244.

If Not Resolved...

You may appeal claim decisions through a formal process with the carrier. Details on the appeal process can be found in the plan documents (full plan books): 

Administrative, Classified and Licensed (not substitutes) Full Plan Books 

     Medical:   Plan 3/Rx B   Plan 5/Rx B   Plan 7/Rx B   Plan 8/Rx B 

     Vision:   Vision Plan 3

     Dental:   Dental Plan 4 with Orthodontia

Licensed Substitute Full Plan Books 

     Medical:   Plan 8/Rx C 

     Dental:   Plan 4 (no orthodontia) 

You may also file a complaint with or seek other assistance from the Oregon Department of Consumer and Business Services, Consumer Protection Section, at (888) 877-4894.