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Asking for Fee-for-Service Oregon Health Plan (OHP) Coverage

When Can You Ask for Fee-for-Service OHP?

We want your coordinated care organization (CCO) to coordinate your medical, dental and behavioral health care. But you can ask for fee-for-service OHP if you have a serious medical reason to see a provider outside your CCO's network.

Questions to Ask Before You Ask for Fee-for-Service OHP:

I​f not, please talk to them about your health care needs. 

  • ​Your CCO is your first contact whenever you need help getting care. 
  • OHP wants your CCO to coordinate your medical, dental and behavioral health care.
  • Your CCO has care coordinators who can help you get the care you need.​
  • Your CCO must help you find ways to get the care you need within your CCO.

​If you don't know, ask. 

If they only work with local CCOs, getting fee-for-service OHP will not help you get the care you need.​

If you only want fee-for-service OHP so that you can keep seeing a behavioral health provider:

  • If approved, you will no longer be enrolled in a CCO for any of your care.
  • This means you can see your fee-for-service behavioral health provider. But you will need to find new medical, dental and pharmacy providers who accept fee-for-service OHP.

​Your CCO can cover some or none your care, depending on the type of provider you need for fee-for-service coverage. 

  • If you need a fee-for-service dental provider, your CCO can still cover medical and behavioral health care.
  • If you need a fee-for-service medical provider, your CCO can still cover behavioral health and dental care.
  • If you need a fee-for-service behavioral health provider, you will no longer be in your CCO. You will need to get all care (medical, behavioral health and dental) from fee-for-service providers.

If You Have a Serious Medical Reason to Not Be in a CCO:

You will need to get proof from your provider that you are:

  • Getting care from a provider who is not in your local CCO, and
  • Changing to a CCO provider would negatively affect your health.

That provider needs to ask OHP for app​roval. Your provider will need to send OHA forms and proof that you need temporary fee-for-service coverage to stay healthy. This includes:

Your provider will talk to OHP about the request. 

  • If you want updates about the request, you will need to ask your provider.
  • If your provider wants updates, they will need to ask OHP Provider Services (800-336-6016).

You will get a letter.

  • The letter will say when this coverage starts and ends.
  • The coverage will last from six to 12 months.

​If you still need temporary fee-for-service coverage after your 6 to 12 month approval period ends:

  • Your provider will need to send a new request to OHA to extend the coverage.
  • Your provider needs to do this at least 30 days before​ your approval period ends.
  • Otherwise, OHP will enroll you in your local CCO the day after your temporary fee-for-service coverage ends.


Member Resources

OHP contacts

Words to know


We want to make sure you have the information you need. 

 Email us 

 Call 1-800-273-0557

Talk to your CCO