Many individuals and businesses in our Oregon communities have been devastated by the wildfires and are continuing to cope with the ongoing challenges posed by COVID-19. At Providence, responding to community needs, especially in times of crisis, has always been at the heart of the healing care provided by our family of organizations.
Our priority continues to be providing our members in Oregon with the support they need to make it through this difficult time. As a result of the State of Emergency declared in Oregon, Providence is taking concrete actions in its coverage and operations to support its members that live in affected areas. These actions are in addition to the COVID-19 measures already in place.
To help providers remain informed and enable you to continue to provide excellent patient care, the following measures are being offered or extended to affected members in Oregon:
- Commercial Fully-Insured and Medicare members can access out-of-network providers at their in-network cost share if they are unable to access any in-network providers due to the fires. Claims will be paid at billed charges, protecting the members from balance billing. Please note: To be administered, members need to call customer service and indicate they have been impacted by the fires. Effective date of service during Sept 1-Nov 17.
- Claims submission timeline extended an additional 6 months for services during Sept 1- Nov 17.
- Special consideration will be given to members and providers impacted by wildfires who are requesting medical services that require prior authorization. If you have questions about a prior authorization, please call 1-800-638-0449.
- From Aug 20 to Nov 17, Providence will allow refills of diabetic supplies and maintenance medications earlier than scheduled (one time, up to a 90-day supply) through a retail pharmacy or via mail order. Members need to notify the mail order pharmacy if they have had a change in address. Medication prior authorization approvals are extended through 11/17/2020.
- Durable Medical Equipment: Medicare members and Commercial Fully-Insured members may replace items (For example, eyeglasses, hearing aids, and orthotics.) that were lost or damaged because of the wildfires. Standard copays and deductible apply. Effective date of service during Sept 1-Nov 17
Additional waiver for Commercial Group and Individual Members:
- An extension on the premium payment grace period through the end of the year (12/31) for commercial groups and individual members. Already in place from COVID-19, this new extension will allow members impacted by the wildfires to continue to receive care and medications.
Additional waivers for Medicare members
- Continued waivers and coverage already in place due to COVID-19
About Providence Health Plan
Providence Health Plan and its affiliates are a part of the integrated delivery system – Providence St. Joseph Health. It provides or administers health coverage to more than 1.2 million program members nationwide. Providence Health Plan responds to the needs of the community by offering insurance for commercial groups, Medicare, Medicaid, individuals and families as well as care management services, network services, workers’ compensation managed care services and population health program. It works with physicians, hospitals and pharmacies to keep patients healthy, and strives to make health care affordable.