Make the most of your benefits

The following tips can help you save when you receive care.

Tip 1: Use your preventive care benefits

Certain preventive services are covered in full when they're received from an in-network provider. Talk with your provider to learn what preventive care is right for you.

Tip 2: Keep your member ID card handy

Carry your member ID with you. You'll need it when you receive services and it includes important information (e.g., your member ID number and contact information) to help you access health care services and navigate the health care system.

The back of your card includes information for Customer Service, ProvRN and provider networks you can access with in-network benefits throughout the nation. The following is an example of a member ID card (please note that your card may look slightly different depending on when it was issued):

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You can view, fax or email your member ID card right from your smartphone when you download the free app in your smartphone's app store. Providence E-Card is available for iPhone, iPad and Android  devices. A four digit PIN and your member identification number are required to access this app. The PIN is located on the bottom right hand corner on the back side of your member ID card.

Need a replacement member ID card? You can order replacement member ID cards through myProvidence. (From the left navigation, under “My Account,” choose “Replacement ID Cards” and following the prompts.) You should receive your new member ID card within 10 business days.

Tip 3: Choose an in-network provider

You’ll typically pay less for services received from an in-network provider. To find an in-network provider, including pharmacies and facilities, refer to the online provider directory. For the best search results, search using your member ID number. 

Tip 4: Maximize your pharmacy benefits

Use the online provider directory to locate an in-network pharmacy and your plan formulary to help you and your physician choose effective medications that minimize your out-of-pocket costs.

Did you know you can purchase a 90-day supply of maintenance medications at preferred retail and mail-order pharmacies? This can save you from making multiple trips, or a trip altogether, to the pharmacy. NOTE: Not all drugs are considered maintenance prescriptions, including compounded drugs, drugs from specialty pharmacies and oncology drugs.

Tip 5: Access the most appropriate care

Knowing when and where to get care is essential to your health and your wallet.

What is an emergency?

An emergency is an accident or sudden unexpected illness that needs to be treated right away or it could result in loss of life, serious medical complications or permanent disability. Examples include:

  • heart attack or severe chest pain
  • loss of consciousness
  • bleeding that does not stop
  • severe abdominal pain
  • stroke, sudden paralysis or slurred speech
  • medically necessary detoxification

In an emergency, go directly to the nearest emergency facility or call 9-1-1. You and your covered family members can receive emergency medical services anywhere, 24 hours a day, even when you're away from home.

What is urgent care?

Urgent care is treatment you need right away for a non-life threatening illness or injury. Examples include:

  • minor cuts or burns
  • ear, nose and throat infections
  • sprains or strains
  • stomachaches
  • headaches or dizziness

Many urgent or immediate care clinics open early, close late and have weekend hours. If you're in doubt of what to do, call your provider or ProvRN. 

ProvRN

ProvRN is available 24 hours a day, seven days a week at 800-700-0481. Call and speak with a registered nurse for advice, including the most appropriate place to receive care for your medical condition. 

Express Care Virtual (where available)

Have a live, on-demand visit with a provider using secure video and audio. Get a diagnosis and treatment recommendation for common medical concerns. It’s safe, secure and confidential, and available 8 a.m. to midnight (Pacific time), 7 days a week. This service is available if you’re physically located in Oregon, Washington, Montana or California. Download the app on Google Play or the App Store, so you’re ready when sick happens. Learn more about Express Care services.

Download on the Apple App Store Download in the Google Store

Tip 6: Protect your children – and yourself – with immunizations

Immunizing your child is one way you can give a head start on the road to health and happiness. Talk with your child's or your health care provider to learn what to do to prevent disease.

Tip 7: Know what services need to be pre-approved before you receive care

Certain services, such as hospitalization and surgery, require a prior authorization before you receive care, meaning the service must be pre-approved by Providence Health Plan. Talk with your provider about getting prior authorization, and refer to your member materials for a list of services that require prior authorization. If care requires prior authorization and you want to receive services from out-of-network providers, you will need to ask your provider to initiate prior authorization.

Tip 8: Use the resources available to you