Tips to make the most of your benefits
Learn how to make the most of your health care benefits. Take advantage of some of the tips below that 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 doctor to see what preventive care is right for you.
Tip 2: Keep your member ID card handy
It includes important information to help you access health care services and navigate the health care system, including your name, member ID number and important contact information.
On the back of your card, you'll also find information for Customer Service and ProvRN as well as provider networks you can access with in-network benefits throughout the nation. Here's an example of your card and important features (please note that your card may look slightly different depending on when it was issued):
Need a new ID card? Log into your myProvidence account and select the link that says "Providence Health Plans." Select the "Order replacement ID cards" link and follow the instructions. You will receive your new member identification card within 10 business days.
You also 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. Download the app by searching for "Providence E-Card" or "Providence Health Plan" in the app store from your smartphone or iPad.
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 for subscribers only. If your ID card does not include a PIN or you need help with your PIN, please call customer service at 503-574-7500 or 800-878-4445.
Tip 3: Receive care from in-network providers and receive a higher level of benefits
To find an in-network provider and access a wide range services, search our online provider directory. The directory contains participating provider listings, affiliated providers, clinics, hospitals and pharmacies. For the best search results, begin your search by entering your member identification number.
Tip 4: Use and save with your pharmacy benefits – choose generics, and have certain medications prior authorized before they are filled
To find an in-network pharmacy, search our online provider directory. Use your plan's formulary – a list of brand-name, generic and specialty medications – that can help you and your physician choose effective medications that minimize your out-of-pocket costs. Plus, take advantage of these additional pharmacy resources.
You can also receive a 90-day supply of your maintenance medications at our preferred retail pharmacies and through the mail order service. Not all drugs are considered maintenance prescriptions, including compounded drugs, drugs from specialty pharmacies and oncology drugs.
Tip 5: Know when and where to receive the most appropriate care
Health care can be confusing, in part because there are multiple options for where and when to receive care. Here's an overview to show which type of care is appropriate at what time.
What is an emergency?
If you or someone close to you is experiencing a medical emergency, getting care quickly is essential. Don't wait. 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 of emergency medical conditions 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?
Many situations are not emergencies, but do require immediate medical attention. Urgent care is treatment you need right away for an illness or injury that is not life threatening, but you cannot wait for a doctor's office appointment. Some conditions for which urgent care would be appropriate include:
- minor cuts or burns
- ear, nose and throat infections
- sprains or strains
- 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 doctor or ProvRN. ProvRN is available 24-hours a day and can direct you to the most appropriate place for care.
ProvRN – medical advice if you're not sure
Call ProvRN Medical Advice Line 24-hours a day, seven days a week at 800-700-0481 to speak with a registered nurse for advice about the most appropriate place to receive care for your medical condition. Or, call your doctor's office if you're not sure what to do.
Express Care Virtual – free care from people you trust for the services you use most
Have a live, on-demand visit with one of our doctors or nurse practitioners 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 or Washington. Download the app on Google Play or the App Store, so you’re ready when sick happens. Learn about all Express Care services.
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. We believe it's the best way to protect your son or daughter from serious infection. We also believe it's the best way for you, as an adult, to protect yourself, as immunity from anything is rarely lifelong. 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 handbook 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 these resources to know about cost and quality before you access care