Many of our clients who are covered by FamilyCare insurance are looking for information regarding what to expect with the closing of FamilyCare effective January 31, 2018.
Oregon Health Authority is working with Health Share of Oregon, Willamette Valley Community Health, and Yamhill Community Care to transition members into their new CCOs by February 1, 2018.
New Horizons Wellness Services, LLC is a FamilyCare in-network provider for Occupational Therapy, Speech Therapy and Psychology services, but our clinic IS NOT a provider with Health Share or other CCOs. Our clinic has reached out to Health Share and the partners that manage their physical health benefits. Our clinic has made attempts to find out how we can become contracted providers. We understand that our clients would like to have an answer to the question,”Is New Horizons Wellness Services going to become a contracted provider with the CCOs?” At this time, we do not know the answer.
For Occupational and Speech Therapy Services: We have been told that the Kaiser, Tuality Health Alliance, and Providence physical health provider networks are not accepting providers. This means that we are not able to become providers for Kaiser, Tuality, and Providence. We have not had a response from CareOregon.
Health Share indicates on their website that physical health plans will honor all medical (including Occupational and Speech Therapy) prior-authorizations from FamilyCare for up to 90 days (through April 2018). However, Health Share and the other physical health plans have not provided a clear billing process, rates or pathway for our clinic to submit and receive payments for services. If they do not provide this information, there will be no way for our clinic to continue to provide Occupational and Speech Therapy Services after January 31st.
For Counseling and Psychology Services and Social Skills Groups: Behavioral health benefits are managed by Clackamas, Multnomah and Washington counties through Health Share’s regional network, Health Share Pathways. Health Share indicates that they will honor mental health prior-authorizations and provider relationships from FamilyCare for up to 180 days (through July 2018) with potential extensions depending on a member’s need.
If you are experiencing difficulty accessing services through your new plan, contact the plan or OHA.
Oregon Health Authority (OHA)
You can reach Oregon Health Plan Client Services at 800-273-0557.
Oregon Health Authority web page dedicated to information about the transition process.
The OHA ombudsperson helps with complaints and problems related to all medical programs operated by the Oregon Health Authority. For assistance contact Ellen Pinney at (503) 947-2347 or 877-642-0450. You can also contact her by email at Ellen.Pinney@state.or.us.
New Member website
Customer Service 503-416-8090 or 1-800-519-3845