Oregon Health Plan
Oregon Health Plan
The Oregon Health Plan provides routine vision exam coverage and eyeglasses only for people under twenty- one years old or for pregnant women of any age. At Portland Eye Care, we are only able to accept the Providence version of the Oregon Health Plan for routine care and eyeglasses. Medical eye care is covered for all members, but you are required to have a an authorization on file from your primary care physician prior to your appointment at our office. If you need to be seen for medical eye care such as treatment of glaucoma, macular degeneration, or other eye condition, please talk to your primary physician before your visit to our office and have them contact your insurance company to authorize a visit to Portland Eye Care.
The Oregon Health Plan has created a number of Coordinated Care Organizations (CCO’s) across the state. These CCO’s then connect you with a health plan that will administer your benefits. In the Portland area, the Oregon Health Plan CCO’s are Family Care and Healthshare. While we are Oregon Health Plan providers, and can accept any Oregon Health Plan insurance for medical eye care as long as there is an authorization on file from your primary care physician, for routine vision exams and glasses it is a bit more complicated.
For routine vision exams and glasses benefits, it depends on which CCO and plan you have. Family Care has contracted with another company called VSP to administer their routine vision benefits, and while we accept most VSP plans, we do not currently accept VSP plans through Family Care. The other CCO, Healthshare, uses four different insurance companies that include Kaiser, Care Oregon, Providence, and Tuality. Of these plans, we accept the Providence Oregon Health Care Plans.
If you have questions about which company is administering your Oregon Health Plan benefits and which providers you are able to visit you can reach Family Care at 503-222-2880 and Healthshare of Oregon at 503-416-8090.