For copies of your Billing Record
If you would like a copy of your OAG billing records for yourself or to send to another person or company, please send us a letter and include the following information:
- Patient’s full name
- Patient’s date of birth
- Date(s) of service or date range of the billing records you want
- Purpose of your request (e.g., personal use, physician, attorney, court, etc.)
- Delivery address
- Patient’s account number, if known
- The requesting person’s name, signature, and date
- The requesting person’s relation to the patient (e.g., self, parent, personal representative)
- If the personal representative is signing the letter on behalf of the patient, please provide a description of your authority to act on behalf of the patient and a copy of official documentation granting this authority.
For Third Parties
If you are a third party (e.g., attorney’s office, car insurance company, etc.) and are initiating a request for a patient’s OAG billing records, please download the Authorization Form below and have the patient complete it.
Where to Send Your Request
You may send your letter or completed Authorization Form to the OAG Corporate Office in one of the following manners:
OAG – Compliance Department
707 SW Washington St., Suite 700
Portland, OR 97205
By Fax: (503) 295-2232
Attention: Compliance Department
Questions about requesting OAG billing records may be directed to the OAG Corporate Office at (503) 299-9906.
PLEASE NOTE: OAG maintains patient billing records for both OAG and Interventional Pain Consultant (IPC) patients. Patients requiring copies of their anesthesia medical records should request them through the facility where they received medical services.