Form OHP3165 Ohp Client Agreement to Pay for Health Services - Oregon

What Is Form OHP3165?

This is a legal form that was released by the Oregon Health Authority - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form OHP3165?A: Form OHP3165 is the Ohp Client Agreement to Pay for Health Services in Oregon.

Q: What is the purpose of Form OHP3165?A: Form OHP3165 is used to establish an agreement between the Oregon Health Plan (OHP) client and health care providers for the client to pay for certain health services.

Q: Who needs to fill out Form OHP3165?A: OHP clients who have been deemed financially responsible for specific health services need to fill out Form OHP3165.

Q: What information is required on Form OHP3165?A: Form OHP3165 requires the client's personal information, health care provider information, and details about the agreed-upon services to be paid for.

Q: Is there a fee for submitting Form OHP3165?A: There is no fee for submitting Form OHP3165.

Q: What happens after Form OHP3165 is submitted?A: After Form OHP3165 is submitted, the agreement becomes effective, and the client is responsible for paying for the agreed-upon health services.

Q: Can the agreement in Form OHP3165 be canceled or modified?A: Yes, the agreement in Form OHP3165 can be canceled or modified by contacting the health care provider or OHP customer service.

Q: What if I cannot afford to pay for the services in Form OHP3165?A: If you cannot afford to pay for the services in Form OHP3165, you can discuss your financial situation with the health care provider or OHP customer service to explore available options.