Frequently Asked Questions

FAQ

• Why was I assigned to a provider when I already have a doctor?

  We match new members with primary care providers (PCPs) based on where the member lives. If you already see a PCP in our network, give us a call. We’re happy to update our records.

• How do I change my primary care provider (PCP), my dentist or my mental health provider?

  To change your PCP or mental health provider, call Columbia Pacific Customer Service at 855-722-8206. We are happy to help you. To change your dentist, call your dental health plan’s customer service phone number.  The number is located on the back of your Columbia Pacific Member ID card.

• If I or someone I know is considering suicide, who can help?

  Talk to someone right away. Here are some numbers you can call:

  • In Clatsop County, call 503-325-5724 (TTY 711).
  • In Columbia County, call 503-782-4499 (TTY 711).
  • In Tillamook County, call 503-842-8201 or 800-962-2851 (TTY 711).
  • You can also call 911 if you are in crisis.
  • Call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or visit suicidepreventionlifeline.org.
  • Call the David Romprey Memorial Warmline at 800-698-2392.
  • Text the Crisis Text Line at 741741.
  • For teen suicide prevention, call YouthLine at 877-968-8491 or text teen2teen to 839863.

• I’m a new member. I need to refill a prescription for medication from my last insurance to get diabetes supplies. What should I do?

  Call Customer Service. You may be eligible for a transitional supply. Talk to your primary care provider as soon as possible about medical supplies and/or drugs that we cover.

• I want to see a specialist. What should I do?

  You don’t need a referral from your PCP. Contact a mental health provider listed in our provider directory or call Customer Service for help.

• Does my plan cover vision services?

  OHP does cover some vision services. Please see the “Vision care” section in your Member Handbook.

• I am pregnant and would like to begin my prenatal care. How can I find a pregnancy provider who will deliver my baby at the hospital I want?

  Our online provider search includes pregnancy providers in our network. You can call our Customer Service and ask which hospitals your provider works with.

• I just moved, had a new baby or changed my name. Who should I contact?

  There are three ways to contact OHP to make updates to your current information:

  1. By telephone (toll-free): 800-699-9075

  Members can call OHP to do any of the following:

  • Change your address, phone number, family status, CCO or other information
  • Replace a lost OHP Card
  • Check the status of your application
  • See if you or your children are still covered by OHP
  • Change plans
  • Solve a problem or make a complaint
  • Get an OHP Client Handbook

  2. By email: oregonhealthplan.changes@state.or.us (When you write to this address, you must include your full name, date of birth, Member ID number and phone number.)

  Existing members can email OHP to change your address, phone number, family status, CCO or other information. PLEASE NOTE: the email address is for changes only.  

  3. Online: Most OHP members can report changes online at ONE.Oregon.gov. The online site supports the following browsers. (If you don't know your browser version, click your browser's Help menu, then click About.)

  • Windows (PC): Internet Explorer 11, Internet Explorer 10, Internet Explorer 9, Internet Explorer 8, Firefox 39.0 and 43.0 and Chrome 43.0 and 44.0.
  • Macintosh: Firefox 39.0 and 43.0 and Chrome 43.0 and 44.0. Safari is not supported.
  • Smartphone browsers are not supported.

  Need help?

  • Learn how to set up your online account. English | Español
  • Learn to use your online account dashboard. English | Español
  • Watch a five-minute overview of the Applicant Portal. 

• I’m a new member and want to know if my medications are covered.

  Columbia Pacific keeps a list of covered drugs, called a formulary. Talk with your doctor about the medications you need. Your doctor may need to submit a prior authorization or change your prescription to a covered drug. Columbia Pacific does not cover mental health drugs. Mental health drugs are covered by OHP. Your pharmacy bills these medications to OHP. If you’re a new member and are unable to fill a prescription, you may qualify for a transition supply. Call us to find out.

• How can I be sure I’ll be able to see who I want under OHP and Columbia Pacific CCO?

  We have a large provider network of hospitals, providers and pharmacies in Clatsop, Columbia and Tillamook counties. We work with you to build a team — providers, mental health specialists, dentists, pharmacists and everyone at Columbia Pacific — to get you high quality care that meets your needs.

• I was in the hospital, and OHP paid for that. But now, I’m getting bills from other providers. What can I do?

  If you get a bill, don’t pay it. Call Columbia Pacific Customer Service right away. We’re happy to help.

• When will I have to pay for medical services on OHP?

  You may have to pay for services:

  • If you see a provider that does not take OHP or is in our provider network. Before you get medical care or go to a pharmacy, make sure they are in our network.
  • If you weren’t eligible for OHP when you received the service.
  • If you sign an agreement to pay for that service — which OHP doesn’t cover — before you receive it.

  If you have two insurances and receive a service covered by OHP, you may have a copayment. You can’t be denied services if you can’t pay your copayment, but you still owe the money to your provider.

• Will Columbia Pacific CCO ever send me a bill?

   

  No. We will never charge you for any covered Medicaid/OHP service.

• I need to see a doctor, but I don’t have my Columbia Pacific CCO Member ID card yet. What should I do?

  Call Columbia Pacific CCO Customer Service at 855-722-8206. We’re happy to help.

• I lost my Member ID card. How do I get a new one?

  Call Customer Service at 855-722-8206 and we can help you.

• Where does the money come from to pay my OHP benefits?

  OHP is paid for by federal and state taxes. The amount is decided by Oregon lawmakers. Funding is passed to Columbia Pacific by OHP, so we can provide you with the care you need.

• What is Columbia Pacific CCO? What is a CCO?

  Columbia Pacific CCO is a coordinated care organization (CCO). We serve Oregon Health Plan (OHP) members in Clatsop, Columbia and Tillamook counties. CCOs are companies that contract with the state of Oregon to manage your health care. They are set up so all your providers — doctors, nurses, counselors, dentists — work together to prevent disease and improve your health. We don’t just treat you when you’re sick. CCOs work with you to keep you healthy and help manage any health conditions you may have.

  For example, there may be added services for members with conditions like diabetes, asthma, heart disease or other health needs.

  For most people, CCOs pay for physical, dental and mental health services. Some people have CCOs only for dental or mental health. The Oregon Health Authority (OHA) pays the CCO a fee every month to take care of many of your health care needs. For services to be covered, you must use providers within the CCO’s provider network.

  CCOs work closely with members, health care providers and the community. They strive to improve the health of the community, give patients better care and find ways to reduce costs.

• How can members contact Columbia Pacific CCO?

   

  Call Columbia Pacific CCO Customer Service:

  • Physical/mental health: 855-722-8206
  • Dental health: Numbers vary depending on your dental health plan. See the Dental Health Resources page for customer service information.
  • TTY: 711

• Who is enrolled in Columbia Pacific CCO?

  Most Oregon Health Plan members who live in Clatsop, Columbia and Tillamook counties.

• What if I want to leave my CCO or change to a different one?

   

  If you want to change to a different CCO, there must be another CCO available that serves the same area. To switch to another CCO from Columbia Pacific, call OHP Customer Service at 800-699-9075. Or, you can email them at oregonhealthplan.changes@state.or.us with your request.

  PLEASE NOTE: The email address above is for changes only. You must include your full name, date of birth, medical ID number and phone number in your email.

  In some communities, there may be only one CCO. If this is true where you live, you can ask the OHP to put you on a fee-for-service plan. This is also called open card OHP. Any OHP member with good reason to have an open card can ask to leave their CCO. Talk to your DHS caseworker or OHP assister about the best way to receive your medical care. If you don't have a caseworker or assister, contact OHP Customer Service at the number listed above.

• How is Columbia Pacific CCO different from a traditional health plan?

   

  Coordinated care organizations (CCOs) were created by the Oregon legislature in 2012. They were looking for new ways to provide better care for OHP members and improve health for Oregon communities. At the same time, they wanted to reduce the cost of medical services offered through OHP.

  Columbia Pacific CCO and our community partners work together to provide a different way of giving care to OHP members. Working within the community, Columbia Pacific CCO:

  • Offers its members physical, dental and mental health services.
  • Provides care that is centered on patients and team-focused.
  • Is local enough to be relevant and large enough to be financially sustainable.
  • Is locally governed by a partnership among local health care providers and community members.
  • Has a Community Advisory Council (CAC) that looks at local health care needs and recommends changes. 

• Who are Columbia Pacific CCO’s partners?

  Columbia Pacific CCO works closely with the following partners in Clatsop, Columbia and Tillamook counties:

  Physical/mental health: CareOregon

  Dental health: Advantage Dental, CareOregon Dental, ODS Community Dental and Willamette Dental Group

• How does Columbia Pacific CCO get input from the community?

  Columbia Pacific CCO has a Community Advisory Council (CAC). It is made up of CCO health plan members, health care providers, and representatives from the community and county government. The CAC ensures that the health care needs of the community are addressed. Learn more about the CAC here.

• How do I report suspected fraud, waste and abuse?

   

  Columbia Pacific CCO takes fraud, waste and abuse seriously. We comply with all applicable laws, including the State and Federal False Claims Act. Examples of fraud, waste and abuse include:

  Provider fraud:

  • Billing for services not rendered
  • Altering medical records
  • Use of unlicensed staff
  • Drug diversion (for example, dispensing substances with no medical purpose)
  • Kickbacks and bribery
  • Providing unnecessary services to members

  
  

  Member fraud:

  • Falsification of information
  • Forging or selling prescription drugs
  • Using transportation benefits for non-medical business
  • Adding an ineligible dependent to the plan
  • Lending or using another person’s insurance card
  • Identity theft

  If you suspect your benefits aren’t being used correctly or want to report fraud, waste or abuse, contact Ethics Point at 888-331-6524. You can also file a report online at ethicspoint.com.

• Who benefits from CCOs?

  CCOs directly benefit Oregon Health Plan members and their families, local health care providers and hospitals. CCOs also benefit everyone in the community, because they identify key health issues for the whole area. Then, they work with local partners to improve health for all.

• How are things different with CCOs?

   

  Before CCOs, OHP members might have had three separate plans for their physical, dental and mental care. Providers for physical, dental and mental health were separate — they weren’t coordinating care. Now, providers efficiently work together to improve the care of each member.

• What are managed care and fee-for-service?

  OHA pays managed care companies a set amount each month to provide their members the health care services they need. Most OHP members must receive managed physical, dental and mental health care.

  Health services for OHP members not in managed care are paid by OHA. This is called fee-for-service (FFS) because OHA pays providers a fee for services they provide. It is also called an “open card.”

  Native Americans and Alaska Natives on OHP can opt in to receive managed care. If you are on Medicare in addition to OHP, you are automatically assigned to a CCO but can opt out. Any OHP member with a good reason to have an open card can ask to leave managed care. Talk to OHP Customer Service about the best way to receive your medical care.

• How can I learn more about CCOs and the Oregon Health Plan?

  Here are some resources for more information:

  • Oregon Health Authority: Spotlight on Oregon’s CCOs
  • Our list of Oregon Health Plan resources

  You can also call us toll-free at 855-722-8206. Information is available in other languages or formats, such as large print, Braille, audio recordings, web-based communications or other electronic formats.