Moda customer service phone number — how to find, use and escalate effectively

Where to locate the correct Moda customer service phone number

Moda is an insurance and healthcare organization with multiple plans, departments and partner lines, and the single “customer service phone number” can differ by product (individual health plan, employer group, Medicare, provider relations, dental, pharmacy, or billing). The most reliable source for the exact number for your membership or issue is your member ID card and the official Moda website (https://www.modahealth.com). Numbers printed on plan documents correspond to the right routing and any automated phone menu options that are specific to your plan year and state.

If you do not have your card, log into the secure member portal on modahealth.com (create an account if necessary) and open the “Contact Us” or “Member Services” area — the portal shows the exact toll‑free number, secure message options and hours for your plan. If you are calling on behalf of a dependent or as a provider, verify you have authorization documented; incorrect routing and privacy law can prevent representatives from discussing account details without proper consent.

Primary phone channels and what they cover

Moda typically separates phone routing by major functional areas: Member Services (eligibility, benefits, ID cards), Claims & Billing, Prior Authorization/Utilization Management, Provider Relations, Pharmacy Help Desk, and Appeals/Grievances. The automated menu or IVR you hear when calling the main line will direct you to these specialized queues — selecting the correct queue reduces handle time and transfers. If the matter concerns a denied claim or prior authorization, ask to be routed directly to Utilization Management or the Claims Appeals unit; these teams have the documentation and authority to start a formal review.

For hearing or speech impaired callers, many U.S. health plans use the relay number 711 or a TTY/TDD line; check your plan materials. International callers and brokers should use the number listed under “Provider & Broker Contacts” on modahealth.com to ensure correct international dialing and time zone handling.

Hours, best times to call, and expected hold times

Call center hours vary by department and state but most member service lines operate Monday–Friday, typically between 8:00 a.m. and 6:00 p.m. local time. Peak call periods are Monday mornings and the 11:00 a.m. – 2:00 p.m. lunch hour; if you want the shortest hold times, call right at opening or mid‑afternoon (2:00–4:00 p.m.) Tuesdays–Thursdays. Expect an efficient vendor to target a service level of answering 80% of calls within 20–30 seconds; if you encounter waits over 15 minutes repeatedly, request a callback option or escalate to a supervisor.

Hold times and speed of answer are operational metrics that can change during open enrollment (Nov–Dec), major network changes, or during public health events. If your issue is time‑sensitive (imminent appointment, urgent medication), indicate “time‑sensitive” or “expedited” at the start of the call so that the representative can prioritize or advise on immediate alternatives.

• What to have ready when you call: member ID number, date of birth, full name as listed on the plan, provider name and NPI (for claims), claim number (if available), dates of service, billing amounts, prior authorization codes, prescription (NDC) and pharmacy name. If calling about appeals, have denial letters and any clinical notes or test dates available.
• Documentation tips: take the rep’s name, reference/case number, the exact time and date of the call, and a brief summary of what was agreed. A call log with these details reduces the chance of repeated rework and is essential for escalating to a manager or filing a formal grievance.

How to escalate: supervisors, grievances and appeals

If initial contact does not resolve the issue, ask for a supervisor and request a written confirmation (email or secure message) of the decision or next steps. For benefit denials you believe are incorrect, request a formal appeal — standard timelines for a health plan appeal are: standard appeal response within 30 calendar days, and expedited (urgent) appeals within 72 hours; these are typical regulatory windows and Moda follows state and federal timelines applicable to the plan type.

To file a formal grievance or external review, follow the process described on modahealth.com in the Appeals & Grievances section; the site lists submission addresses, fax numbers and any online upload portals. If a dispute cannot be resolved internally, members are entitled to contact their state’s insurance regulator or request an independent external review. Document all steps and preserve copies of medical records or bills you submitted.

Alternate contact channels and practical resources

Phone is often fastest, but alternative methods can produce better documentation and traceability. Use the secure member portal for document uploads and message trails; email is rarely used for protected health information unless via a secure messaging system. Many issues (ID cards, prescription formulary updates, provider directories) can be resolved through the website without a phone call.

• Official website and resources: https://www.modahealth.com — primary source for current phone numbers, plan documents, provider directories and secure member login.
• In-person or written communication: check plan materials for corporate or regional office addresses if you must submit notarized forms or physical appeals. For legal notices, use the address on official communications or the corporate contact listed on the website.

Final practical tips: always verify the phone number from your member ID or the official website before calling, keep careful notes of every interaction (times, names, case numbers), and escalate immediately for time‑sensitive care. These steps shorten resolution times and preserve your appeal rights if disputes arise.

How do I speak to Medicaid customer service?

★ Department of Health Care Services

1. California State Contacts.
2. Eligibility.
3. Enrollment.
4. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

How do I cancel my Moda plan?

You can cancel your policy by calling Customer Service, or the agent through whom it was purchased. If you decide to cancel your policy within the 10-day right to examine, any premiums paid will be refunded, minus the non-refundable $20 application fee.

What is the phone number for Moda customer service?

For questions about your Moda Health medical and vision coverage, please contact Medical Customer Service at 503-382-5337 or toll-free at 800-960-4637. For questions about your dental coverage, please contact Dental Customer Service at 503-382-5338 or toll-free at 800-964-4637.

Is there a grace period for Moda?

Grace periods and claims pending
If premiums are paid during the grace period there is no interruption of coverage. Individual members who receive the advance premium tax credit (APTC) and have paid one month’s premium are eligible for a three-month grace period.

Is Moda only in Oregon?

(Moda) is an Oregon-domiciled health care service contractor that provides medical plans to more than 90,000 insured medical members in Oregon and Alaska. Moda is also licensed to transact health insurance in Washington, Idaho, California and Texas, but is not currently offering insurance products in these states.

Is Moda insurance leaving Oregon?

Beginning January 1, 2025, Moda will no longer be offering Medicare Advantage plans in the state of Oregon. For Medicare Advantage member support for 2024 plans, see our member support page. We have greatly valued the trust placed in us to provide health insurance to Medicare beneficiaries within our community.