Payment, Insurance and Billing

We know insurance and billing can be overwhelming and we are happy to help. We’ve gathered the information people need most here. Please review it to see if we’ve addressed your question. If we haven’t, or if you still need help, we’re here to help. Contact our Revenue Cycle Department at 541-687-4905 or RevenueCycleManagement@oregonmed.net. We are open Monday through Friday from 8 am to 4:45 pm.
 

Payment options for out-of-pocket costs

Payment for your visit and services is due at the time of service, including co-payments, co-insurance and unmet deductibles. If we are unable to provide you with the total for the portion of the visit that is not covered and that you must pay “out of pocket,” OMG will bill you. Your payment is due in full when you receive the statement. There are several ways to pay:

 

How health insurance billing works

After your visit, Oregon Medical Group will bill your insurance carrier on your behalf. In order to do this, we will need a copy of your insurance card with complete and accurate information of your health plan. We will also need your full name, address, phone number, date of birth and insurance identification number. If any of the information is incomplete or incorrect it could result in a denial from your insurance carrier. The accuracy of this information is the patient’s responsibility, therefore you could be held responsible for the balance if your carrier denies due to inaccurate or incomplete information.  
 
The insurance carrier will notify OMG of the amount of your visit that is covered by insurance and what is your responsibility (co-pays, co-insurance, or deductible amount). At that point, you will receive a bill for the balance. That balance is due as soon as you receive of the first account statement from OMG. If any part of the balance becomes delinquent, then the account balance may be forwarded to an outside agency for collection.  
 
Please note that the timeline for insurance processing varies by insurance company. You may not immediately receive a bill because of that. Do not assume that if you have not yet been billed, that there is no balance due.


Insurance (commercial) coverage

We currently accept coverage from the following health plans:
  •  First Choice Health (Network)
  •  First Health Coventry (Network)
  •  Multi Plan (Network)
  •  Providence Preferred (Network)
  •  Cigna Health Care
  •  Health Net Health Plan of Oregon
  •  Lifewise Health Plan of Oregon
  •  Moda Health Plans
  •  PacificSource Health Plans
  •  Providence Choice Plan (PEBB Medical Home only)
  •  Providence EPO
  •  Regence BCBS
  •  TRICARE
  •  United HealthCare 
     
If your insurance plan is not listed, we may still participate through one of our network contracts. Please call our New Patient Representative at 541-242-4444 for additional information. (Please note: Due to federal government restrictions, we are not allowed to answer questions about specific plans or to make plan recommendations.)

 

Medicare

This year the federal government has set the open enrollment period for October 15 through December 7, 2019.  During this time, you need to select which Medicare insurance coverage you are going to use for 2020. Learning about Medicare options can be overwhelming, especially when you are just turning 65. We would like to help you make an informed choice that makes the most sense for you and your health.  
 

Things to consider when choosing a Medicare health plan include

  • Can I continue seeing my OMG Primary Care Physician on the health plan I am considering?
  • Are my prescriptions covered by this plan?
  • Is my pharmacy in this plan’s network?
  • Am I able to get the care I want for a cost I can afford?
  • Does this plan include the benefits that are most important to me?
To compare your current Medicare or Medicare Advantage health plan to the health plans we currently accept, please visit Medicare’s Find Health & Drug Plans to begin your search. Medicare covers a “welcome to Medicare” preventive visit, as well as a yearly “wellness” visit.

Between January 1 and March 31, 2020, you can try out your CCO plan and change it if you aren't  happy with your 


Medicaid 

Oregon Medical Group will be contracting with PacificSource in 2020, which administers the Oregon Health Plan (OHP) Medicaid program in Lane County. You have between January 1 and March 31, 2020, to try out and change your CCO plan if you like. For more information about OHPs CCO plans and how to switch, click here.  

Medicare Advantage 

We believe the best way to be healthy is to stay healthy. That is why we encourage our Medicare patients to choose a Medicare Advantage plan accepted by Oregon Medical Group. Medicare Advantage plans help you and your provider work together to keep you healthy through prevention, care coordination and disease management. More than 11,000 Oregon Medical Group patients are benefiting from Medicare Advantage plans.  

  • Medicare Advantage plans must, at a minimum, provide the same benefits as Original Medicare.
  • Many Medicare Advantage plans include additional services and benefits not provided by other Medicare programs (i.e. vision, dental, gym memberships).
  • The Medicare Advantage plans we contract with encourage disease prevention and chronic care management which significantly improves quality of care and reduces overall healthcare costs.
  • Prescription drug (Part D) coverage is also included with most Medicare Advantage plans, providing convenience of one bundled product.
  • With Medicare Advantage, you will not need Medigap (supplemental) coverage.

You can learn more about Medicare Advantage by speaking directly with a health plan below. This list is not an endorsement, but simply intended to help you get started with your research:  
 

Appealing or correcting a bill

If you believe there is an error on your account, please call us at 541-687-4905 as soon as you discover it. If you prefer email, please contact us at RevenueCycleManagement@oregonmed.net.

 

Questions about outstanding balances

If there is a balance on your account after your insurance carrier has paid that portion, it means there are unpaid copayments, coinsurance, or unmet deductibles according to your benefit plan with your health insurance carrier. Please contact your health insurance carrier directly if you have questions about the health services that your insurance plan may or may not cover, or about any amount that they have assigned to you as “patient responsibility”.

 

If your insurance carrier or coverage changes

If your health insurance coverage has changed and may affect payment for services that have already been provided, please contact our Billing Department at 541-687-4905. If the changes will only affect future services, simply provide your new health insurance card and information to us at your next visit.

 

Bills from other medical organization for tests or services ordered by OMG providers

Your OMG provider may have ordered medical services from another medical facility. The group completing the testing will bill you and your insurance separately from Oregon Medical Group. Examples of items or procedures that you may receive a separate bill for include surgery, anesthesia, labs, hospital or surgery center, and any durable medical equipment (braces, crutches, etc.) If you have questions about the billing from non-OMG medical facilities, please contact that provider using the information on the statement you received.

 

Diagnosis code questions or disputes

It is OMG’s responsibility to ensure that the healthcare coding and billing that we submit to you or your insurance carrier accurately reflects the services that were provided to you during your visit. If you disagree with the billing, please contact us at 541-687-4905 or via email at RevenueCycleManagement@oregonmed.net. Note that coding is prescribed by others, and OMG is required to follow these guidelines. We are very careful to follow all federal, state, and local coding and billing rules and guidelines.

 

Physical Therapy billing questions

Our Physical Therapy Department is a contracted service provided by Therapeutic Associates. You will receive a bill from Oregon Medical Group for your visit to our physical therapy department.


Free discount prescription card

As a resident of Oregon, you and your family have access to a Prescription Drug Card program that is free. Simply download your Prescription Drug Card and receive savings of up to 75 percent at more than 50,000 national and regional pharmacies. Visit www.oregonrxcard.com to print your free card!

 

Frequently asked billing questions

  • For questions regarding your bill, please contact our Billing Department at (541) 687-4905. The Billing Department is open Monday-Friday from 8:00 am to 4:45pm.

     

  • Send an email to pe@oregonmed.net. In the subject line please list the clinic name where you are a patient. In the body of the email please include your name, best number to reach you at, procedure name, expected date of procedure, if the surgery is scheduled at a hospital or surgery center, and the Current Procedural Terminology (CPT) code. An escalation specialist will contact you by phone within 48 hours. All price estimates are only estimates and subject to change.

     

  • Please contact our Revenue Cycle Department by phone at 541-687-4905 or by email at RevenueCycleManagement@oregonmed.net and we will work to resolve your concern as soon as possible.

     

  • The balance remaining after your insurance has paid results from any unpaid copayments, coinsurance, or unmet deductibles according to your benefit plan with your health insurance carrier. Please contact your health insurance carrier directly if you have questions about the health services that your insurance plan may or may not cover, or about any amount that they have applied to your patient responsibility.

     

  • If your health insurance coverage has changed and may affect payment for services that have already been provided please contact our Revenue Cycle Department at
    541-687-4905. If the changes will only affect future services, please provide your new health insurance card and information to us at your next visit.

     

  • You may have medical services ordered by your Oregon Medical Group healthcare provider which are completed by other medical facilities. The group completing the testing will bill you and your insurance separately from Oregon Medical Group. If you have questions about the billing from other medical facilities, please contact the specific medical facility.

     

  • It is our responsibility to ensure that the healthcare coding and billing that we submit to you or your insurance carrier accurately reflects the services that were provided to you during your visit with our provider. We are very careful to follow all federal, state, and local coding and billing rules and guidelines. If you disagree with the billing please contact our Revenue Cycle Department.