{"id":"oscar-health","page":"https://escalate.alexgaoth.com/#/c/oscar-health","html":"https://escalate.alexgaoth.com/c/oscar-health/","generated":"2026-10-15","company":{"id":"oscar-health","name":"Oscar Health","aliases":["oscar","oscar insurance","hioscar"],"sector":"insurance_health","website":"https://www.hioscar.com","account_url":"https://www.hioscar.com/auth/login","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"},{"id":"account-message","type":"portal","label":"Message the Care Team, view EOBs and pay bills in the Oscar account","value":"https://www.hioscar.com/auth/login","purposes":["claim_denial","claim_delay","billing_error"],"access":"login","source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"},{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"},{"id":"fl-appeals-mail","type":"mail","label":"Oscar grievances and appeals, Florida (Attn. Grievances)","value":"Oscar Insurance, Attn. Grievances, P.O. Box 52146, Phoenix, AZ 85072","purposes":["claim_denial","poor_service","billing_error"],"notes":"From the Florida grievance and appeal form. Fax 888-977-2062; email help@hioscar.com. Other states: check the Evidence of Coverage or the state forms page.","source":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","last_verified":"2026-10-12"},{"id":"fl-appeal-form","type":"web_form","label":"Oscar grievance and appeal form, Florida (PDF)","value":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","purposes":["claim_denial","poor_service"],"notes":"Linked as \"Oscar Grievance Static Form\" on the Florida forms page. Completing the form is optional; a letter works too.","source":"https://www.hioscar.com/forms/2025/fl","last_verified":"2026-10-12"},{"id":"forms-phone","type":"phone","label":"Help finding forms","value":"+1-855-672-2788","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"},{"id":"forms-page","type":"web_form","label":"Oscar forms (grievance form, prescription reimbursement, member rights)","value":"https://www.hioscar.com/forms","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","channel":"member-services-phone","note":"Or message the Care Team in the Oscar account."},{"rung":"written_complaint","channel":"grievance-form","note":"Internal grievance or appeal."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for individual and family plans; complaint to the state."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Ask the Care Team for the reason, file a grievance or appeal, then ask for external review through the state.","evidence":["EOB or denial letter","member ID card","medical records","provider letter of medical necessity"],"steps":[{"do":"Read the EOB in your account. Ask the Care Team by message or phone for the reason, the appeal deadline and the appeal address.","channel":"account-message"},{"do":"File the grievance or appeal in writing as the denial letter instructs. Florida members can mail, fax or email the grievance and appeal form.","channel":"fl-appeals-mail"},{"do":"For an urgent appeal where there is imminent danger to life, limb or health, call 855-672-2755.","channel":"member-services-phone"},{"do":"After the final internal denial, ask for external review through your state insurance department."}],"facts":[{"kind":"process","claim":"Oscar's Florida grievance and appeal form says completing the form is optional, lists mail, fax and email for submission, and tells members with an urgent appeal or grievance involving imminent danger to life, limb or health to call 855-672-2755.","issues":["claim_denial"],"source":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Compare the bill with the EOB, then ask the Care Team.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB in your account.","channel":"account-message"},{"do":"Call or message the Care Team about the difference. Ask the provider to rebill to the EOB amount.","channel":"member-services-phone"},{"do":"If it is not fixed, file a grievance.","channel":"grievance-form"}],"facts":[{"kind":"contact","claim":"Oscar tells members with EOB questions to call the Care Team at (855) 672-2755 or message the Care Team through the account.","issues":["billing_error"],"source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}]},{"issue":"surprise_medical_bill","summary":"Contact Oscar right away, compare the bill with the EOB, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":"account-message"},{"do":"Contact the Care Team right away.","channel":"member-services-phone"},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}],"facts":[{"kind":"process","claim":"Oscar says that if lab work is sent to a lab other than BioReference, LabCorp or Quest Diagnostics, members should contact Oscar right away for help, to avoid a surprise bill.","issues":["surprise_medical_bill"],"source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}]}],"known_blockers":["Oscar publishes appeal deadlines in each plan's Evidence of Coverage; only the Florida grievance and appeal address was confirmed.","EOBs and Care Team messages need an Oscar account login."],"notes":"Oscar sells individual and family (IFP) plans on and off the exchange in several states, plus employer products. Appeal rules and external review depend on the state.","official_domains":["hioscar.com"],"security":{"report_phishing":[{"id":"siu-email","type":"email","label":"Oscar Special Investigation Unit (report suspected fraud, waste and abuse)","value":"Fraud@hioscar.com","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"compliance-hotline","type":"phone","label":"Oscar Compliance and fraud hotline","value":"+1-844-392-7589","notes":"Reports can be anonymous.","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"online-report","type":"web_form","label":"Oscar online compliance and fraud report (hosted by EthicsPoint)","value":"https://secure.ethicspoint.com/domain/media/en/gui/66399/index.html","access":"open","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"}]}},"playbooks":{"claim_denial":{"company":{"id":"oscar-health","name":"Oscar Health","sector":"insurance_health","website":"https://www.hioscar.com","account_url":"https://www.hioscar.com/auth/login"},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Ask the Care Team for the reason, file a grievance or appeal, then ask for external review through the state.","evidence":["EOB or denial letter","member ID card","medical records","provider letter of medical necessity"],"steps":[{"do":"Read the EOB in your account. Ask the Care Team by message or phone for the reason, the appeal deadline and the appeal address.","channel":{"id":"account-message","type":"portal","label":"Message the Care Team, view EOBs and pay bills in the Oscar account","value":"https://www.hioscar.com/auth/login","purposes":["claim_denial","claim_delay","billing_error"],"access":"login","source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}},{"do":"File the grievance or appeal in writing as the denial letter instructs. Florida members can mail, fax or email the grievance and appeal form.","channel":{"id":"fl-appeals-mail","type":"mail","label":"Oscar grievances and appeals, Florida (Attn. Grievances)","value":"Oscar Insurance, Attn. Grievances, P.O. Box 52146, Phoenix, AZ 85072","purposes":["claim_denial","poor_service","billing_error"],"notes":"From the Florida grievance and appeal form. Fax 888-977-2062; email help@hioscar.com. Other states: check the Evidence of Coverage or the state forms page.","source":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","last_verified":"2026-10-12"}},{"do":"For an urgent appeal where there is imminent danger to life, limb or health, call 855-672-2755.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"do":"After the final internal denial, ask for external review through your state insurance department."}],"channels":[{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"},{"id":"account-message","type":"portal","label":"Message the Care Team, view EOBs and pay bills in the Oscar account","value":"https://www.hioscar.com/auth/login","purposes":["claim_denial","claim_delay","billing_error"],"access":"login","source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"},{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"},{"id":"fl-appeals-mail","type":"mail","label":"Oscar grievances and appeals, Florida (Attn. Grievances)","value":"Oscar Insurance, Attn. Grievances, P.O. Box 52146, Phoenix, AZ 85072","purposes":["claim_denial","poor_service","billing_error"],"notes":"From the Florida grievance and appeal form. Fax 888-977-2062; email help@hioscar.com. Other states: check the Evidence of Coverage or the state forms page.","source":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","last_verified":"2026-10-12"},{"id":"fl-appeal-form","type":"web_form","label":"Oscar grievance and appeal form, Florida (PDF)","value":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","purposes":["claim_denial","poor_service"],"notes":"Linked as \"Oscar Grievance Static Form\" on the Florida forms page. Completing the form is optional; a letter works too.","source":"https://www.hioscar.com/forms/2025/fl","last_verified":"2026-10-12"},{"id":"forms-phone","type":"phone","label":"Help finding forms","value":"+1-855-672-2788","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"},{"id":"forms-page","type":"web_form","label":"Oscar forms (grievance form, prescription reimbursement, member rights)","value":"https://www.hioscar.com/forms","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"Oscar's Florida grievance and appeal form says completing the form is optional, lists mail, fax and email for submission, and tells members with an urgent appeal or grievance involving imminent danger to life, limb or health to call 855-672-2755.","issues":["claim_denial"],"source":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.","source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For urgent care claims, a group health plan must decide an appeal \"not later than 72 hours after receipt of the claimant's request for review\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"An external review must be requested within \"4 months after the date you receive a notice or final determination\" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to strictly follow the internal claims and appeals requirements, the claimant \"is deemed to have exhausted the internal claims and appeals process\", subject to a de minimis exception.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.","source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"Group health plan initial decisions: urgent care claims \"not later than 72 hours after receipt of the claim by the plan\"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims \"not later than 30 days after receipt of the claim\", with one extension of up to 15 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Disability claims: notice of decision \"not later than 45 days after receipt of the claim by the plan\", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have \"at least 60 days following receipt of a notification\" of the adverse determination.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to establish or follow these claims procedures, \"a claimant shall be deemed to have exhausted the administrative remedies available under the plan\" and may bring a civil action under ERISA section 502(a).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Or message the Care Team in the Oscar account.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal grievance or appeal.","channel":{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for individual and family plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Oscar publishes appeal deadlines in each plan's Evidence of Coverage; only the Florida grievance and appeal address was confirmed.","EOBs and Care Team messages need an Oscar account login."],"security":{"official_domains":["hioscar.com"],"never_asks":[],"known_scams":[],"report_phishing":[{"id":"siu-email","type":"email","label":"Oscar Special Investigation Unit (report suspected fraud, waste and abuse)","value":"Fraud@hioscar.com","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"compliance-hotline","type":"phone","label":"Oscar Compliance and fraud hotline","value":"+1-844-392-7589","notes":"Reports can be anonymous.","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"online-report","type":"web_form","label":"Oscar online compliance and fraud report (hosted by EthicsPoint)","value":"https://secure.ethicspoint.com/domain/media/en/gui/66399/index.html","access":"open","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"}]},"credibility":{"grade":"B","primary_share":0.846,"sources":{"primary":11,"other":2},"verified_from":{"page":13},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade B (good: mostly official pages; check the flagged values before relying on them). 85% of 13 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Oscar sells individual and family (IFP) plans on and off the exchange in several states, plus employer products. Appeal rules and external review depend on the state.","warnings":[]},"billing_error":{"company":{"id":"oscar-health","name":"Oscar Health","sector":"insurance_health","website":"https://www.hioscar.com","account_url":"https://www.hioscar.com/auth/login"},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Compare the bill with the EOB, then ask the Care Team.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB in your account.","channel":{"id":"account-message","type":"portal","label":"Message the Care Team, view EOBs and pay bills in the Oscar account","value":"https://www.hioscar.com/auth/login","purposes":["claim_denial","claim_delay","billing_error"],"access":"login","source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}},{"do":"Call or message the Care Team about the difference. Ask the provider to rebill to the EOB amount.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"do":"If it is not fixed, file a grievance.","channel":{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"},{"id":"account-message","type":"portal","label":"Message the Care Team, view EOBs and pay bills in the Oscar account","value":"https://www.hioscar.com/auth/login","purposes":["claim_denial","claim_delay","billing_error"],"access":"login","source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"},{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"},{"id":"fl-appeals-mail","type":"mail","label":"Oscar grievances and appeals, Florida (Attn. Grievances)","value":"Oscar Insurance, Attn. Grievances, P.O. Box 52146, Phoenix, AZ 85072","purposes":["claim_denial","poor_service","billing_error"],"notes":"From the Florida grievance and appeal form. Fax 888-977-2062; email help@hioscar.com. Other states: check the Evidence of Coverage or the state forms page.","source":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/382ef1433c60f8cb1c3b1259e8131d33ca2285de.pdf","last_verified":"2026-10-12"},{"id":"forms-phone","type":"phone","label":"Help finding forms","value":"+1-855-672-2788","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}],"facts":[{"kind":"contact","claim":"Oscar tells members with EOB questions to call the Care Team at (855) 672-2755 or message the Care Team through the account.","issues":["billing_error"],"source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.","source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"The seller must obtain \"a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Or message the Care Team in the Oscar account.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal grievance or appeal.","channel":{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for individual and family plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Oscar publishes appeal deadlines in each plan's Evidence of Coverage; only the Florida grievance and appeal address was confirmed.","EOBs and Care Team messages need an Oscar account login."],"security":{"official_domains":["hioscar.com"],"never_asks":[],"known_scams":[],"report_phishing":[{"id":"siu-email","type":"email","label":"Oscar Special Investigation Unit (report suspected fraud, waste and abuse)","value":"Fraud@hioscar.com","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"compliance-hotline","type":"phone","label":"Oscar Compliance and fraud hotline","value":"+1-844-392-7589","notes":"Reports can be anonymous.","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"online-report","type":"web_form","label":"Oscar online compliance and fraud report (hosted by EthicsPoint)","value":"https://secure.ethicspoint.com/domain/media/en/gui/66399/index.html","access":"open","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"}]},"credibility":{"grade":"B","primary_share":0.846,"sources":{"primary":11,"other":2},"verified_from":{"page":13},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade B (good: mostly official pages; check the flagged values before relying on them). 85% of 13 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Oscar sells individual and family (IFP) plans on and off the exchange in several states, plus employer products. Appeal rules and external review depend on the state.","warnings":[]},"surprise_medical_bill":{"company":{"id":"oscar-health","name":"Oscar Health","sector":"insurance_health","website":"https://www.hioscar.com","account_url":"https://www.hioscar.com/auth/login"},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"Contact Oscar right away, compare the bill with the EOB, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":{"id":"account-message","type":"portal","label":"Message the Care Team, view EOBs and pay bills in the Oscar account","value":"https://www.hioscar.com/auth/login","purposes":["claim_denial","claim_delay","billing_error"],"access":"login","source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}},{"do":"Contact the Care Team right away.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"},{"id":"forms-phone","type":"phone","label":"Help finding forms","value":"+1-855-672-2788","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"Oscar says that if lab work is sent to a lab other than BioReference, LabCorp or Quest Diagnostics, members should contact Oscar right away for help, to avoid a surprise bill.","issues":["surprise_medical_bill"],"source":"https://www.hioscar.com/for-members/faqs","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Or message the Care Team in the Oscar account.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal grievance or appeal.","channel":{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for individual and family plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Oscar publishes appeal deadlines in each plan's Evidence of Coverage; only the Florida grievance and appeal address was confirmed.","EOBs and Care Team messages need an Oscar account login."],"security":{"official_domains":["hioscar.com"],"never_asks":[],"known_scams":[],"report_phishing":[{"id":"siu-email","type":"email","label":"Oscar Special Investigation Unit (report suspected fraud, waste and abuse)","value":"Fraud@hioscar.com","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"compliance-hotline","type":"phone","label":"Oscar Compliance and fraud hotline","value":"+1-844-392-7589","notes":"Reports can be anonymous.","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"online-report","type":"web_form","label":"Oscar online compliance and fraud report (hosted by EthicsPoint)","value":"https://secure.ethicspoint.com/domain/media/en/gui/66399/index.html","access":"open","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"}]},"credibility":{"grade":"B","primary_share":0.846,"sources":{"primary":11,"other":2},"verified_from":{"page":13},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade B (good: mostly official pages; check the flagged values before relying on them). 85% of 13 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Oscar sells individual and family (IFP) plans on and off the exchange in several states, plus employer products. Appeal rules and external review depend on the state.","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"Or message the Care Team in the Oscar account.","channel":{"id":"member-services-phone","type":"phone","label":"Oscar Care Team (member services)","value":"+1-855-672-2755","hours":"Mon-Fri 8 a.m.-8 p.m.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"The number on the back of the member ID card takes precedence.","source":"https://www.hioscar.com/get-coverage/member-services-team","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal grievance or appeal.","channel":{"id":"grievance-form","type":"web_form","label":"Grievance form","value":"https://www.hioscar.com/member/grievances/","purposes":["claim_denial","poor_service","billing_error"],"notes":"The form page needs JavaScript; its fields could not be read automatically.","source":"https://www.hioscar.com/forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for individual and family plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["hioscar.com"],"never_asks":[],"known_scams":[],"report_phishing":[{"id":"siu-email","type":"email","label":"Oscar Special Investigation Unit (report suspected fraud, waste and abuse)","value":"Fraud@hioscar.com","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"compliance-hotline","type":"phone","label":"Oscar Compliance and fraud hotline","value":"+1-844-392-7589","notes":"Reports can be anonymous.","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"},{"id":"online-report","type":"web_form","label":"Oscar online compliance and fraud report (hosted by EthicsPoint)","value":"https://secure.ethicspoint.com/domain/media/en/gui/66399/index.html","access":"open","source":"https://www.hioscar.com/compliance","last_verified":"2026-10-12"}]},"credibility":{"grade":"B","primary_share":0.846,"sources":{"primary":11,"other":2},"verified_from":{"page":13},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade B (good: mostly official pages; check the flagged values before relying on them). 85% of 13 sources are the organization's own pages or government sites.","dossier_last_verified":null},"dossier":null,"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}