Q
| What is a medical home in Providence Choice?
|
A
| A medical home is a clinic staffed by health care professionals who work together as a team. Click here to see the list of medical home clinics in Providence Choice. Led by your primary provider, this team coordinates all of your health care, including referrals to outside providers or specialists when necessary. The team gives you connected health care by staying informed about and actively participating in all aspects of your care.
|
Q
| Why do I have to choose a medical home in Providence Choice?
|
A
| You need to choose a medical home by Jan. 1, 2011, to ensure you have access to the full benefits of your Providence Choice Plan, including claims paid at the medical home benefit level. Click here to see and compare the benefits in this plan with others.
|
Q
| Where are the new medical homes, and how do I find one?
|
A
| The Providence Choice network now includes 14 medical homes in the Portland Metropolitan area (Multnomah, Clackamas, Washington, Yamhill and Clark counties) and in the Marion-Polk, Lane, Linn-Benton, Deschutes and Curry county areas. Click here to view the list of medical homes.
|
Q
| I live in Salem. Will I be able to find a medical home for myself and my family members?
|
A
| Three of the 14 medical home clinics added to the network for plan year 2011 are in the Salem area. See the list of medical homes in your area, and call the medical home of your choice to ask whether they are accepting new patients.
|
| Q | If I live in a county with medical homes but none are in my town, will I be able to get care through the hospital in my town? |
| A | All hospitals are considered in-network for necessary emergency care. Your providers in your medical home clinic will refer you to the appropriate facilities, including hospitals, for necessary care; those facilities are considered in-network with the referral. |
Q
| Why does Providence Choice have medical homes only in certain counties and not other areas of the state?
|
A
| Decisions on the Providence Choice network expansion were influenced primarily by Providence Health Plans’ commitment to providing PEBB members with the best experience of care possible. To ensure a consistent level of care, PEBB and Providence Health Plan selected the most advanced primary care practices that could maintain and elevate standards in regard to technical readiness, leadership commitment, and cultural orientation.
|
| Q | I live in a county with the rural subsidy; will it apply if I enroll in Providence Choice? |
| A | No. The rural subsidy applies only for members who live in a designated rural county and who are enrolled in PEBB’s Statewide Plan. If you enroll in Providence Choice and choose to use providers who are not part of your medical home (or referred by your medical home), you will be responsible for paying the higher, out-of-network share of the cost of care. In addition, the provider can bill you for the balance of costs not paid by the plan. |
Q
| How can my current provider join the Providence Choice network?
|
A
| PEBB and Providence Choice anticipate further expansion of Providence Choice for 2011-12. Providence welcomes discussions with providers about joining the medical home network. Ask your provider’s office to contact their Providence Health Plan provider relations representative or call 503-574-7750.
|
Q
| If I enroll in Providence Choice, will my medical home take care of moving all my medical records from my current providers to my medical home? Will I have to pay?
|
A
| Your records should be moved to your new medical home at no cost to you. For your own protection, your current provider’s office may ask you to sign a release before they are able to transfer your personal health information.
|
Q
| If the medical home I choose for myself doesn’t have a pediatrician, will I have to pay out-of-network if I want my child to continue seeing his current pediatrician?
|
A
| With more than 35 pediatricians in the Providence Choice network of medical homes, there’s a good chance your current pediatrician will be one of them. Click here to see the list of pediatricians. If your pediatrician is not currently in the medical home network, ask the pediatrician’s office to contact their Providence Health Plan provider relations representative or call 503-574-7750.
|
Q
| If I don’t like the care I get in my medical home, can I switch plans midyear?
|
A
| You need to be comfortable with your providers and feel you are getting the care you deserve. While members are only able to switch plans during the open enrollment period or with certain midyear changes, you can always change your medical home and provider within the Providence Choice network of medical homes.
|
| Q | If my current doctor is in the network for PEBB’s Statewide Plan and also in one of the new medical home clinics, do I have to change plans?
|
| A | You can continue to see your doctor as an in-network provider in the Statewide Plan. Expansion of the Providence Choice plan gives members in some areas of the state an additional option.
|
Q
| If I am pregnant when the new plan starts, can I continue to see my current obstetrician or midwife?
|
A
| Yes. You do not need a referral to see your current obstetrician or midwife, even if the provider is not part of your medical home or the plan’s network.
|
Q
| If I am hospitalized when the new plan starts, will I be able to use my Providence Choice benefits or the benefits from my old plan?
|
A
| You will be covered by the plan you are enrolled in at the time your hospitalization begins. Once your initial hospitalization has concluded, you will be covered by the plan in effect at that time. For example, if you are hospitalized on Dec. 30, 2010, and you are a Statewide Plan member, your hospital stay will be covered under your Statewide Plan benefits. If you are released from the hospital on Jan. 3, 2011, and begin physical therapy, your physical therapy and any other medical care received from that point forward will be covered under your Providence Choice benefits.
|
Q
| If I have a surgery scheduled in the new plan year, will I be able to have the surgery with my current provider?
|
A
| If you choose to have surgery or any other medical procedure in the new plan year with a provider who is not part of your medical home, you will pay out-of-network costs. You should make sure your current provider’s office is aware of your plan change so they can properly coordinate your services.
|
Q
| Why does the Providence Choice plan add a $100 copay for sleep studies and advanced imaging in 2011?
|
A
| The Providence Choice plan includes new copayments that encourage members to explore lower-cost, lower-risk procedures and diagnostic tests that may offer similar, equal or better outcomes. You should receive the most appropriate treatment for your condition, so talk to your provider about the options available to you.
|
Q
| If I take my online health assessment as a PEBB Statewide member, and then enroll in Providence Choice, will I have to take the assessment again to receive my no-cost Weight Watchers® benefit?
|
A
| No. Your assessment is valid for the plan year in which you completed it, and will transfer along with your other account information on myprovidence.com when you register as either a member of the Statewide Plan or Providence Choice.
|