Dispute Charge Process

Our goal is to provide the high quality healthcare. We show our commitment to our members by publishing our privacy policies.



Dispute Process for Charges From your Provider

Please review the following scenarios to determine how to dispute the
Point of Service
 charges.

Emergency care
If you believe the care was due to an emergency you may file a  claim appeal. You may review the ONA Healthcare definition of  emergency care to determine if an appeal is appropriate.

You contacted your Primary Care Doctor (PCD) after the service, you did not know a referral was needed, the service was a follow up to preventive care, or you did not realize the referral had expired
As a ONA Healthcare member it is your responsibility to be aware of the referral requirements. Point of Service charges cannot be waived if you did not follow the referral requirements. Your PCD/hospital or clinic cannot submit a retroactive referral for these circumstances.

Your PCD/hospital or clinic appointment line/referral manager failed to submit the referral to OHC or gave you misinformation
OHC advises members to contact the hospital’s or clinic’s patient advocate to determine if he/she will submit a referral for services already rendered. If the referral is approved, members can then contact OHC for a claim adjustment. There are no review rights through OHC for this circumstance and the local hospital or clinic determination is final.

Your PCD failed to submit the referral to OHC or the referral was submitted and rejected
If your PCD gave you a written referral, but did not submit a
referral to OHC, you may submit a copy of the written referral. If the referra was verbal, you may submit a written statement from the provider indicating when the verbal referral was given. Submit the documentation with a copy of the Explanation of Benefits to:

ONA Healthcare Claims Correspondence
897 Cayo Grande Ct
Thousand Oaks, CA 91320-1946             
       

Misinformation
from an OHC customer service representative
If our customer service records indicate misinformation or
incomplete information was provided, the Point of Service charges may be
adjusted. You may submit a request for review online or via U.S. mail.

Email
via secure Encryption
I to [email protected]

U.S.
mail:
 
ONA Healthcare Claims Correspondence
897 Cayo Grande Ct
Thousand Oaks, CA 91320-1946 

Other reasons not listed above
You may submit a request for review online or via U.S. mail.

Email
via secure Encryption
I to [email protected]

U.S. mail:
ONA Healthcare Claims Correspondence
897 Cayo Grande Ct
Thousand Oaks, CA 91320-1946