FAQs

• What is Providence Preferred?
• Who is eligible for Providence Preferred?
• Does Providence Preferred pay claims?
• What are the benefits of using Providence Preferred physicians and hospitals?
• How is health care provided to participants of Providence Preferred?
• What about emergencies?
• Can Providence Preferred answer questions about benefits and deductibles?
• What happens if the employer's benefit plan does not cover a service received from a preferred provider?
• Are all provider specialties listed in the directory?
• What is a Primary Care Provider?
• Do participants of Providence Preferred have to choose a primary care provider?
• What if my family doctor isn't listed in the Providence Preferred provider directory?
• How much do I pay up front when I see a provider?
• What if I need surgery or hospitalization?
• How do I know if my doctor is a Providence Preferred provider?
• Who can be contacted for more information about Providence Preferred?

Providence Preferred is a network of practitioners, hospitals and ancillary medical providers throughout Oregon and southwest Washington designed to manage the cost, delivery and quality of health care. Providence Preferred gives you the flexibility of choosing your own physicians within our panel of more than 60 hospitals and 13,000 providers. View the Providence Preferred service area map (PDF 391kb).

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Participants whose employer or union trust offers Providence Preferred for your health benefit plan are eligible.

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Providence Preferred is a provider network, not an insurance company and therefore does not pay claims. If your self-insured employer, union trust or your employer's insurance company contracts with Providence Preferred you could receive medical services at a discounted rate.

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• Participants receive quality health care from some of the area's most respected private practice providers and hospitals.
• The employer's health insurance may offer a higher level of benefits when using Providence Preferred providers and hospitals.
• Employers will save money through lower out-of-pocket expenses. Participating physicians and hospitals agree to accept preferred rates for services provided to Providence Preferred eligibles.
• There is no additional paperwork. Providers and hospitals take care of the billing.
• Providence Preferred providers are responsible for all pre-approval requirements through the employer's Medical management program. It's always a good idea to make sure that all pre-approvals have been done before a participant enters the hospital or doctor's office for a procedure.

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A participant chooses a provider or hospital from the Providence Preferred directory. Providence Preferred Customer Service can provide verification of the selected provider's participation. Participants identify his or her self as "Providence Preferred eligible" when making an appointment. Each participant should bring his or her identification card with them to the doctor's office. Participants may be responsible for a copay if his or her health plan has one for provider visits. The provider will bill Providence Preferred or the employer's insurance carrier automatically for the remainder of the visit.

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In a case of a life-threatening emergency, the participant should always go to the closest hospital. If it is a Providence Preferred participating hospital, Providence Preferred savings will apply. For minor emergencies or urgent care, the participant may want to choose a provider, clinic or hospital listed in the Providence Preferred directory. For more information on the difference between urgent care and emergency care, please reference our Urgent and Emergency Care page.

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Providence Preferred provides a panel of preferred (contracted) providers and has no information regarding your deductibles, premiums and coverage. Participants should contact their employer or insurance company regarding any benefit questions.

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For services not covered by the employer's health plan, the participant will be responsible for paying the provider's usual and customary fee.

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There is a wide variety of providers in the Providence Preferred network. Participants should check with their employer's insurance carrier/trust to make sure that the provider or specialist is covered by the employer's health plan.

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A Primary Care Provider (PCP) is the person who manages the majority of a patient's primary health care needs. A PCP can be a family practitioner, internist, pediatrician, general practitioner, and in some cases certain women's health care providers, nurse practitioners, and physician's assistants.

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Although most people decide to use a Primary Care Provider for most of their medical needs, it is not a required element of Providence Preferred.

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The answer depends on your health plan benefits. Most plans offer the flexibility to stay with your current physician, even if he or she isn't listed in our directory. However, you should check with your primary health plan to be sure.

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This answer, again, depends on whether your overall health plan requires you to make a copayment for medical services. If a copayment is required, the amount is usually listed on your membership card and is due at the time of your visit. If a copayment is not required, your claim goes to your health plan and is applied to your deductible and coinsurance. Be sure to bring your health plan identification card whenever you receive medical care to ensure that your benefits are applied accurately and promptly. Please note that some providers may ask for an optional partial payment upfront to reduce the outstanding balance on your account.

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Check with your physician to ensure that surgical procedures have been preauthorized. Preauthorization may be required for both inpatient stays and outpatient surgeries. Your health plan identification card lists the phone number for authorization of those services.

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You have an option of viewing our online provider directory, or you can contact Providence Preferred Customer Service at 503-574-7600 or 1-800-793-9338.

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For any questions other than benefits and eligibility verification, please contact Providence Preferred at 503-574-7600 or 1-800-793-9338.

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