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2025 Provider Directory guidance for
Individual Health Plans
ASKING THE RIGHT QUESTION
One of the toughest part of evaluating an insurance plan is to understand what provider network your plan offers and how to talk to doctors office about this. My best advice is to get the precise name of your plan's network, then check your providers to make sure they accept your specific network. Let's say you have a PacificSource plan that uses the Navigator Network.
Do not ask the office "Do you accept PacificSource?" Ask them "Do you accept specifically the PacificSource Navigator Network?". If the admitting person replies "Yes we accept PacificSource, ask again specifically "Can you double-check that you accept the Navigator Network? If the front office person hedges, call the business office to confirm. I stress this because PacificSource offers 15 networks, and a medical office may just accept 3 or 4 of these networks. Save yourself some trouble of finding out your visit was 'out of network'.
To help you find contract providers I have update the network information for 2024 by company. If you ever have trouble and would like my assistance looking up providers I am happy to help.
KAISER PERMANENTE
The In-network providers with Kaiser include all of the Kaiser providers in Oregon and other Kasier providers nationwide. As of 2024, Kaiser Members can no longer utilize the non-Kaiser Portland Clinic Offices.
Click Here to search Kaiser Providers
MODA HEALTH PLAN
PROVIDER NETWORK:
Moda uses a broad network of providers called the Beacon Network in the Portland area. When you travel outside of Oregon, they use a national network called the Aetna PPO Network for Emergency and Urgent Care.
CONTRACTED HOSPITALS:
Moda only contracts with OHSU, Portland Adventist, and Tuality Community Hospitals in the Portland area. (not Providence or Legacy Hospitals)
Click Here to search Moda Providers
PROVIDENCE HEALTH PLANS
MEDICAL HOME REQUIREMENT:
When you enroll in a Providence Plan you are required to select a Medical Home Primary Care Clinic, not a specific primary care provider. A Medical Home Clinic is where you go for Primary Care. You can your MHC selection anytime through your myProvidence portal or by calling Customer Service. For 2024 a referral to a Specialist physician is no longer required. Just verify that they are in the same provider network. Emergency Room and Urgent Care visits are the only services covered outside of your network nationwide. However, you will pay more if you do not go to an In-Network Urgent Care.
3 DIFFERENT PROVIDER NETWORKS:
Providence plans for 2024 will use one of 3 different provider networks: The Connect, Choice, or Signature Network. The plan name will indicate what Network the plan uses. The Connect Network is the generally the smallest of the 3, but may work fine for you. The Signature Network is a national network of providers, but the p. Make sure the doctors you want to use accept the plan network you are a part of by using the search tool below:
Click Here to search Providence Providers
CONTRACTED HOSPITALS:
In the Portland area Providence Glisan St. Vincent, Milwaukie, Willamette Falls, and Newberg Hospitals are in network.
PACIFICSOURCE
the Navigator Network in Oregon, Washington, Idaho and Montana. When you travel outside of those 4 states you can use provider in the Aetna Signature Administrators Network (case of a child in college out of state)
ASSOCIATED HOSPITALS LOCALLY:
You are not required to select a Primary Care Doctor (PCP) when you enroll, and referrals are not required. Legacy Meridian Park, Good Samaritan, Emmanuel, and Mt. Hood Medical are covered in the Portland area, as well as Tuality, OHSU and Adventist Hospitals. (Not Providence) Silverton and Salem are also in the network.
REGENCE INDIVIDUAL PLANS
PROVIDER NETWORKS:
The Regence plans offer one of 2 networks and the network name will be in the plan name.
LEGACY NETWORK: Some plans utilize the smaller Legacy Network of providers. Associated hospitals include Legacy Emanuel, Good Samaritan, Meridian Park, Mt. Hood Medical and Silverton.
INDIVIDUAL & FAMILY NETWORK: This is the larger network of contracted doctors which includes both Adventist, OHSU and Tuality hospitals in addition to the 5 Legacy Hospitals.
Click Here to search Regence Providers
NEED HELP?
I recognize that looking for doctors that match up with your plans network can be a challenging thing to do. I've been using these provider directories for 20 years now and I can be of assistance if you need help or are having problems. Send me an email of the problem are having or doctor type you are looking for and I'll try to help.
If you want to email me a list of doctors (first and last names) to danneils@gmail.com, I'd be happy to help you look them up in any of the provider search engines. You can also give me a call at 503-650-4325
UPDATED 7/10/24
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