OHP and FamilyCare FAQs

Here are some quick answers to common questions. If you don't see your question here, please feel free to call us at 503-222-2880 or toll-free at 800-458-9518. We're happy to help.

 

 

General Family Care and OHP Questions

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What is FamilyCare, Inc.?
FamilyCare is a Coordinated Care Organization (CCO). We manage the benefits of over 125,000 Oregon Health Plan members. As a CCO, we have a network of local healthcare providers, hospitals, and social agencies who have agreed to work together to deliver all types of care to meet their patients’ needs.  

How can I join FamilyCare? 
People enrolled in the Oregon Health Plan (OHP) who live in Clackamas, Multnomah, and Washington counties can join FamilyCare; a small segment of people who live in Marion county are also eligible. When you first sign up for OHP you have the option to join a CCO. If you are placed with a different CCO you can switch to FamilyCare. Call the Oregon Health Plan at 800-699-9075 (TTY 711) to request a change. 

How do I get an Oregon Health Plan application or re-application?
You will need to enroll for the Oregon Health Plan through the Oregon Health Authority (OHA). You can apply for OHP at any time throughout the year. If you need to reapply for OHP, you will also do that through the OHA. Remember, it is the state that approves applications or re-applications, not FamilyCare.

Who do I contact if my address or phone number changes, if I lose my Oregon Health ID card, or if I become pregnant or have a new baby? 
Please call Oregon Health Plan Customer Service at 800-699-9075 as soon as possible to report these changes and/or to request a new ID card. 

Who do I call if I have other insurance coverage (for example, Worker’s Compensation or private health insurance)?
Please call FamilyCare Navigation Services at 503-222-2880 or toll-free 800-458-9518 (TTY 711). We’re here to take your call from 8 a.m. to 5 p.m., Monday through Friday, and 9 a.m. to 5 p.m. on weekends.

I was supposed to be with a different plan. How can I switch to another CCO?
You can request to change your CCO in the first 90 days after you enroll. Contact OHP Customer Service at 800-699-9075 (TTY 711).

Are interpretation services available if I do not speak English?
Yes. If you need an interpreter for provider visits, or to help you with questions, please call FamilyCare Navigation Services at 503-222-2880 or toll-free 800-458-9518 (TTY  711). We’re here to take your call from 8 a.m. to 5 p.m., Monday through Friday, and 9 a.m. to 5 p.m. on weekends.

How long will I be eligible for medical benefits?
Unfortunately, we do not have that information. Please contact OHP Customer Service at  800-699-9075 (TTY 711).

What if I have an emergency when I am out of town?
If you are traveling and have an emergency, go to the nearest emergency room or call 911. Be sure to show your Oregon Health ID card and FamilyCare ID card to the office or hospital and give them your Primary Care Provider’s name and phone number. If you travel outside the United States (including to Canada or Mexico), you are not covered by the Oregon Health Plan. To coordinate follow-up care, call your Primary Care Provider.


Family Care and OHP Benefits Questions

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How can I find out what benefits I have?
To find out what benefits Oregon Health Plan offers, see Your OHP Benefits. For more detailed information on your coverage, see the FamilyCare OHP Member Handbook or call us.   

Do I have dental coverage?
Most FamilyCare plans cover basic dental care services such as regular dental exams and routine procedures. For more information, see Your OHP Benefits

Who is eligible for routine vision benefits?
FamilyCare covers routine eye exams and visual services for pregnant members and members under age 21. FamilyCare will pay for medical eye exams and glasses for non-pregnant clients who are 21 years of age and older, only under certain conditions. For more information, see Your OHP Benefits

Do I need a referral to see an OB/GYN?
Maybe. Routine women’s health services, such as well-woman exams, do not require a referral. Other services may require a referral. To find a provider, see Find a Provider. If you learn you are pregnant call OHP customer service. 

Do I have mental health coverage?
FamilyCare covers behavioral health and addiction services for adults, children, and families. These include inpatient, outpatient, and home-based services. For more information, see Behavioral Health and Addictions Support Services.

Does FamilyCare cover drug and alcohol treatment?
Most outpatient behavioral health services, such as meeting with a therapist, do not require a referral from your primary care provider (PCP) or pre-authorization, so long as you see a contracted FamilyCare provider. For more information, see Behavioral Health and Addictions Support Services.

Is medical equipment covered?
Your provider will need to write a prescription for any medical equipment you may need. Supplies to help manage diabetes, such as test strips and lancets, are covered at no cost to you. Other types of equipment, such as wheelchairs and oxygen concentrators, may need prior approval. 

Is acupuncture covered?
Acupuncture may be covered under certain conditions. Your provider will need to submit a prior authorization to FamilyCare Health. 

Which hospitals can I go to?
If you think you have a real emergency, call 911 or go to the Emergency Room (ER) at the nearest hospital. You don’t need permission to get care in an emergency. An emergency might be:

•    Chest pain
•    Trouble breathing
•    Bleeding that won’t stop
•    Broken bones
•    A mental health emergency

Please do not use the ER for things that can be treated in your provider’s office.

Is medical transportation available?
OHP provides transportation services for non-emergency care. This includes provider appointments and urgent care visits. To schedule a ride, please call Ride To Care, our new transportation provider. Ride To Care can be reached at 855-321-4899 between 7 a.m. and 7 p.m. Please schedule rides at least two days in advance. If your appointment is more than two days away, you can also schedule your ride online. You will need to know details about your appointment, including location, appointment time, and whether or not you will need a ride home.


Prescription Drug Questions

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Are prescription drugs covered? 
Under your FamilyCare plan, thousands of prescription drugs are covered, with no cost to you. To find out which ones are covered, please see the FamilyCare formulary in the Find a FamilyCare OHP Drug section. 

I am new to the plan and take a medication that’s not on the FamilyCare formulary. Can I keep getting it?
You will have a 90-day transition period when you join our plan to switch to a medication that is in our formulary. Please talk with your Primary Care Provider about an alternative. If there are no alternatives, you may ask your provider to request an exception by contacting FamilyCare.

What if my prescription needs prior approval?
If your prescription is denied by the pharmacy, it may be because the medication needs prior approval. Please call your provider's office as soon as possible, or ask the pharmacy to call your provider. Your provider will have to submit a request to FamilyCare asking for approval.

In most cases, the review is done within 24 hours of receiving your provider's paperwork. It can take up to 72 hours to process a prescription request so do not wait until you are out of medication to request a refill. Call your pharmacy directly to see if your medication was approved. 

 

Billing and Payment Questions

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Do I have to pay any co-pays?
There are no out-of-pocket costs for covered services.  See your FamilyCare OHP Member Handbook for more details.

What should I do if I get a bill for healthcare services?
If you receive a bill, please call your healthcare provider’s office to make sure they know you are on the Oregon Health Plan. Let them know they are to send the bill to FamilyCare. To avoid confusion, please take your Oregon Health ID card with you to all of your appointments.

 

Questions for Parents, Legal Guardians and Care Providers

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How can I access a loved one’s health information or make sure I’m able to speak on their behalf?

To protect our members, FamilyCare will not release medical information to anyone without the proper authorization. If you want us to share your information please contact our Navigation Services Department at 503-222-2880 to have a “Protected Health Information Use & Disclosure Authorization” form mailed to you for signature.

       

Glossary

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Below you will find the definitions of new terms, words and abbreviations that may come up in relation to the Oregon Health Plan and FamilyCare.
 
Acute Care: Intensive, psychiatric services provided on a short-term basis to a person experiencing significant symptoms of a mental health disorder that interferes with a person’s ability to perform activities of daily living. 

Care Coordination: A process-oriented activity that provides ongoing communication and collaboration with children and families with multiple needs. The activity can include: facilitating communication between the family, natural supports, community resources, and involved child-serving providers and agencies; organizing, facilitating and participating in team meetings at which strengths and needs are identified and safety planning occurs. The activity provides for continuity of care by creating linkages to and managing transitions between levels of care and transitions for older youth to the adult service system. 

Case Management: A goal-oriented activity that assists children, youth and families that could include: identifying strengths and needs; identifying, brokering and linking to community services and resources; assisting in obtaining entitlements; advocating on behalf of families; providing support and consultation to families; facilitating access to intensive services; and providing crisis planning, prevention, and intervention services. 

Family: Parent or parents, legal guardian, siblings, grandparents, spouse and other primary relations whether by blood, adoption, legal or social relationship. 

LMP (Licensed Medical Practitioner): A person who is a physician, nurse practitioner and/or physician's assistant licensed to practice in the State of Oregon whose training, experience and competence demonstrates the ability to conduct a comprehensive mental health Assessment and provide Medication Management. The LMHA or Contractor must document that the person meets these minimum qualifications. 

Medicaid: A federal and state funded portion of the Medical Assistance Program established by Title XIX of the Social Security Act, as amended, and administered in Oregon by the Department of Human Services. The program provides medical assistance to people who qualify based on income, age, or health status. 

OHP (Oregon Health Plan): Oregon’s Medicaid program. OHP provides Oregonians access to coordinated health care. It covers services such as regular check-ups, prescriptions, mental health care, addiction treatment, and dental care. 

OHP (Oregon Health Plan) Member: An individual found eligible by a program of DHS to receive health care services under the OHP Medicaid Demonstration Project or State Children’s Health Insurance Program and who is enrolled with contractor under this Agreement. 

OHP Member Representative: A person who can make Oregon Health Plan related decisions for OHP Members who are not able to make such decisions themselves. An OHP Member Representative may be, in the following order of priority, a person who is designated as the OHP Member’s health care representative, a court-appointed guardian, a spouse, or other family member as designated by the OHP Member, the Individual Service Plan Team (for OHP Members with developmental disabilities), a Department of Human Services (DHS) case manager or other DHS designee. For OHP Members in the care or custody of DHS’s Children, Adults and Families Services or Oregon Youth Authority (OYA), the OHP Member Representative is DHS or OYA. For OHP Members placed by DHS through a Voluntary Child Placement Agreement (SCF form 499), the OHP Member shall be represented by his or her parent or legal guardian. 

Oregon Youth Authority (OYA): The Department created by the 1995 Legislative Assembly that has responsibility for care and housing of child and adolescent offenders adjudicated and sentenced by juvenile justice to the juvenile correction system. 

Outpatient Hospital Services: Covered services received in an outpatient hospital setting where the OHP member has not been admitted to the facility as an inpatient, as defined in the DHS Hospital Services Guide.

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