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2022 Provider Directory guidance

 

    One of the toughest part of evaluating insurance plans is understanding the provider network being offered and how to find those 'In Network' providers for your plan.   I will hopefully demystify this a little on this web page.  I'll share a little information first for each company relation to the Individual Health Plans (Not Medicare Advantage).  

COMPANIES ADDRESSED BY NAME:   
 Kaiser, Moda, PacificSource, Providence, Regence, Bridgespan
 

Kaiser Individual Plans:   

    The In-network providers with Kaiser include all of the Kaiser providers in Oregon & the non-Kaiser,  The non-Kaiser Portland Clinic offices across the Portland area are also considered 'In Network'.   Kaiser providers in other states are also considered in network.


 CLICK HERE TO SEARCH KAISR PROVIDERS

 
     To search providers in the non-Kaiser, Portland Clinics offices you can click on the link below: 
 
  

 

Providence Individual Plans


UNDERSTAND THE "MEDICAL HOME" REQUIREMENT: 

        When you enroll in a Providence Plan, you are required to select a Medical Home Primary Care Clinic in the first month of coverage.  So you are not selecting a primary care doctor, rather you are selecting a 'Medical Home Clinic' where you will receive Primary Care.   If you want to see someone outside of your Medical Home clinic, you need to ask for a referral.   

UNDERSTAND THE 2 PROVIDER NETWORKS--CONNECT AND CHOICE NETWORK

         The Providence plans in the Portland area work with either the larger Choice Network, or the smaller Connect network.  Some providers only accept the Choice plan, so do check your doctors to see if they accept the Connect network before you select the plan.  Click below to search for Providence Providers

 

CLICK HERE to search Providence Providers
 

CONTRACTED HOSPITALS IN THE PORTLAND AREA: 
Providence Glisan St., St. Vincent, Milwaukie, Willamette Falls, and Newberg Hospitals.  

 

PacificSource Individual Plans:


    For 2022, PacificSource utilizes the Navigator Network in the Portland area.  You are not required to select a Primary Care Doctor (PCP) when you enroll, and referrals are not required.   The Navigator Network will be available statewide and will now include OHSU, Adventist and Tuality hospitals starting in 2022.
   
   When you travel outside of Oregon you can see providers in the national First Choice Network with providers available in most states.   In Alaska they use the First Choice network of providers. Click below to search PacificSource Providers.
 
 
CONTRACTED HOSPITALS IN OREGON: Meridian Park, Good Samaritan, Emmanuel, and Mt. Hood Medical in the Portland area and now Tuality, OHSU and Adventist Hospitals.
 
 

Moda Health Individual Plans:

     Moda uses a large network of providers called the Beacon Network in the Portland area.  When you travel they us the first health national network.     

Click below 
to search providers.

 
 
CONTRACTED HOSPITALS IN OREGON:
       Moda contracts with OHSU, Portland Adventist, and Tuality Community Hospitals in the Portland area.

 
 

 REGENCE 3 NETWORKS FOR 2021:

      Regence is really confusing for 2021.   They are offering 3 sets of plans that use 3 different networks:  The Individual & Family Network, the Legacy Health Network, and the OHSU Health Network.   
 

Individual & Family Network:   
This is the largest network of contracted doctors among the 3 Regence plans.   The contracted hospitals  in the portland area includes OHSU, Adventist, Tuality, Newberg Providence and Shriners Hospital in the Portland area.  
Click below
 to search providers:

https://web.healthsparq.com/healthsparq/public/#/one/
insurerCode=RG_I&brandCode=RG_OR&productCode=N272952796

 

CONTRACTED HOSPITALS in Portland area:  OHSU, Portland Adventist, Providence  Tuality:   Peacehealth in Vancouver.

LEGACY LHP NETWORK:   
The Legacy LHP Network utilizes a network of doctors related to the Legacy Hospitals in the Portland area.


CONTRACTED HOSPITALS:  Meridian Park, OHSU, Good Samaritan, Emanuel, Mt. Hood Medical, Salmon Creek

https://web.healthsparq.com/healthsparq/public/#/one/
insurerCode=RG_I&brandCode=RG_OR&productCode=P1008395766


OSHU HEALTH NETWORK:    

     The OHSU Health Network includes a variety of doctors surrounding the OHSU and Adventist medical systems.  

https://web.healthsparq.com/healthsparq/public/#/one/
insurerCode=RG_I&brandCode=RG_OR&productCode=P1008395766

 
CONTRACTED HOSPITALS:  OHSU, Portland Adventist, Tuality Community
 
 
 
NEED HELP?

    I recognize that looking for doctors that match up with your plans network can be a challenging thing to do.  I've been using these provider directories for 18 years now and I can be of assistance if you need help or are having problems.   Send me an email of the problem are having or doctor type you are looking for and I'll try to help.
 
    If you want to email me a list of doctors (first and last names) to danneils@gmail.com, I'd be happy to help you look them up in any of the provider search engines.   You can also give me a call at 503-650-4325    
 
     

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