2023 Provider Directory guidance for
Individual Health Plans
One of the toughest part of evaluating an insurance plan is the provider networks being offered and how to find those 'In Network' providers for your plan.
I hope this page will help you locate the providers you are seeking. These links only search the Individual Plans, not Medicare or Small Group networks.
When you ask your medical provider if they accept a company, it is more important to ask if they are in the specific network that corresponds to your medical plan. Here is an example of how your conversation should go: "Do you accept the PacificSource Navigator Network? "Yes, we accept PacificSource (they reply)", "Can you check to make sure you specifically accept the Navigator Network? Thank you! "
It is important that they not just accept that company, but the specific network you plan utilizes.
The In-network providers with Kaiser include all of the Kaiser providers in Oregon and other Kasier providers nationwide. In the Portland area you can also visit the non-Kaiser, Portland Clinic offices :
CLICK HERE to search Kaiser Providers
Kaiser members can also visit the non-Kaiser Portland Clinic offices around the Portland area with over 100 providers to choose from.
PROVIDENCE HEALTH PLANS
UNDERSTAND THE "MEDICAL HOME" REQUIREMENT:
When you enroll in a Providence Plan you are required to select a Medical Home Primary Care Clinic, not a Primary Care doctor. A Medical Home Clinic is where you go for Primary Care. You can change clinics anytime through your myProvidence portal or by calling Customer Service. You have access to in-network Specialists only with a referral from your Medical Home clinic. Emergency Room and Urgent Care visits are the only services covered outside of your network.
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 Network and not the Connect Network. So do check your doctors to see if they accept the Connect network before you select the plan. The plan name will reflect which network it utilizes.
CLICK HERE to search Providence Providers
CONTRACTED HOSPITALS IN THE PORTLAND AREA:
Providence Glisan St., St. Vincent, Milwaukie, Willamette Falls, and Providence Newberg Hospitals.
PACIFICSOURCE HEALTH PLANS
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 2023.
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 THE PORTLAND AREA:
Meridian Park, Good Samaritan, Emmanuel, and Mt. Hood Medical in the Portland area, as well as now Tuality, OHSU and Adventist Hospitals. (Not Providence)
MODA HEALTH PLAN
Moda uses a network of providers called the Beacon Network in the Portland area. When you travel outside of Oregon, they use a national network called the Aetna PPO Network for Emergency and Urgent Care.
CLICK HERE to search Moda Providers
Moda contracted hospitals in the Portland areas:
Moda contracts with OHSU, Portland Adventist, and Tuality Community Hospitals in the Portland area. (not Providence or Legacy)
REGENCE INDIVIDUAL PLANS
Regence plans offer either the The Individual & Family Network, or the lower cost Legacy LPN Network. (The OHSU network is discontinued.) The plan name will reflect which network it uses.
1. Individual & Family Network:
This is the larger network of contracted doctors. The contracted hospitals in the Portland area includes Legacy Emmanuel, Good Samaritan, Mt. Hood Medical, Meridian Park, OHSU, Adventist, to name a few in the Portland area. (Not Providence).
2. Legacy LHP Network:
This network is smaller than the Individual and Family network and does not include Adventist or OHSU hospitals in network. Doctors may also vary by network.
CLICK HERE to search Regence Providers
When you search for providers be sure you have selected the correct area and network in the top right corner.
Regence contracted hospitals in the Portland areas:
The Legacy LHP Network includes Legacy Meridian Park, Emmanuel, Good Samaritan, and Mt. Hood Medical. The Individual and Family Network also includes OHSU, Adventist, and Tuality General.
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 20 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 email@example.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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