Frequently Asked Questions

FAQ

Frequently Asked Questions about the Oregon Health Plan

What are the advantages of being a member of a Coordinated Care Organization (CCO)?

  • Access to a network of healthcare providers.
  • Access to preventive services, such as weight management and tobacco cessation.
  • Increased quality of care. CCOs have systems for improving quality of care for all its members
  • Help prevent emergencies and trips to the hospital and emergency room
  • Give you a health care team to work with.
  • Help all your care-givers, including family members, become part of your care team
  • Share information to avoid repeat or unneeded testing
  • Give you the tools and support you need to stay healthy
  • Give you advice that is easy to understand and follow.

How do I sign up for the Weight Management Program? First, talk to your Primary Care Provider (PCP) and ask them to refer you to our Weight Management Program. If your PCP agrees that you could benefit from the Weight Management Program, they will give you a referral. You can then call WOAH Customer Service at 800-264-0014, TTY 877-769-7400 to set up a time to come in to start the program. We offer the program in Coos and Curry Counties. The program includes access to local pools, gyms, and the TOPS program.

How do I sign up for the Smoking Cessation Program? Talk to your primary care provider about quitting tobacco and if medication is right for you. You can attend free Tobacco Cessation classes. WOAH covers nicotine patches, gum, or lozenges for up to two quit attempts per year with a prescription from your provider. You must attend a Tobacco Cessation class to receive other medications, including nicotine inhaler, spray, and Chantix.

What is Western Oregon Advanced Health? A Coordinated Care Organization (CCO) that services Oregon Health Plan members in Coos and Curry Counties. WOAH provides physical, dental, mental and substance use treatment. We work with community partners to provide high quality of care and service to our members.

How can I join Western Oregon Advanced Health (WOAH)?  When you enroll in the Oregon Health Plan you can choose to join Western Oregon Advanced Health (WOAH) if you live in Coos or Curry Counties. To enroll in the Oregon Health Plan, you can go online to OregonHealthCare.gov or you can request a paper application be mailed to you by calling OHP Customer Service at 1-800-699-9075.  If you are already enrolled in OHP and you want to be assigned to WOAH, you should call OHP Customer Service at 1-800-699-9075.

How do I get an application for Oregon Health Plan? There are several ways that you can apply for the Oregon Health Plan (OHP). You can call OHP Customer Service at 1-800-699-9075 to request that an application be mailed to you, you can go online to www.OregonHealthCare.gov and complete the application online, or you can call or go to Waterfall Community Health Center (541-756-6232) in North Bend or Coast Community Health Center (541-347-2529) in Bandon and Port Orford and have an Application Assister help you apply.

Who do I contact if my address or phone number changes? Please contact Oregon Health Plan Customer Service at 1-800-699-9075.

How do I get my new baby signed up for the Oregon Health Plan? Within two weeks after your baby is born, call the Oregon Health Plan Customer Service at 1-800-699-9075.

How do I get a new OHP ID card? The Oregon Health Authority sends each person on Oregon Health Plan  ID card. Contact the Oregon Health Plan Customer Service at 1-800-699-9075 if you have questions. WOAH also provides a cut-out ID of a card for you to fill in.

What if I don’t receive a card or don’t know my ID number? You can call WOAH Customer Service and ask for your ID number. You can call Oregon Health Plan customer service for a new print out of your ID card at 1-800-699-9075.

Are interpretation services available? In what languages? Yes, interpretation services are available. If you have questions regarding your CCO plan you can call WOAH customer service at 800-264-0014 or 541-269-7400. The languages available are Spanish, Russian, Vietnamese, Somali, Arabic Burmese, Simplified Chinese, Bosnian, Cambodian, Lao, Romanian, traditional Chinese.

What benefits do I have on OHP? The Oregon Health Plan provides medical, dental, mental health and substance use treatment benefits.  For more information about your benefits, please call WOAH Customer Service at 800-264-0014, TTY 877-769-7400.

When do I need to get a referral? If you are needing to see a specialist in the area of Coos or Curry County your primary care provider can call the specialist and refer you over the phone.  You will need a referral from your primary care provider sent to WOAH for review if you are seeing a specialist out of the area.

Is transportation to my appointment available? Yes. You may contact Translink at 1-888-518-8160 or your CCO for transportation information at 541-269-7400.

Are prescription drugs covered? Yes, WOAH has a formulary (list of medications) that are covered at no charge to you.

The medication that I use is not on the WOAH Formulary? Can I keep getting it? Your primary care provider may submit a prior authorization (PA) request to determine if the medication will be paid for by WOAH. WOAH is a mandatory generic health plan, therefore, if a generic formulation of your medication is available you will need to use the generic medicine. Not all medications will be covered by WOAH. Medications used to treat conditions that are not covered by Oregon Health Plan will not be paid for. If there is a medicine that works the same and is less expensive you will need to use the less expensive medication.

When does my prescription need prior approval? Any medication that is not on the Western Oregon Advanced Health formulary, or costs more than $300, will require a prior authorization.  Opioids are allowed with a quantity limit of a 30 day supply per 180 day period may be covered without a prior authorization  for acute conditions.  Opioid use beyond 30 day supply will need a prior authorization  from your Primary Care Provider.

How do I find a primary care provider? Please call WOAH Customer Service at 800-264-0014, TTY 877-769-7400 to be assigned a Primary Care Provider (PCP). If we do not hear from you after you have been on our plan for 30 days, we will assign you a PCP.  If you have a PCP already and the PCP is a WOAH provider we can assign you to that PCP.

How do I find a dentist? You can contact the Advantage Dental Plan at 1-866-268-9631. This is the plan that will help you with your dental needs.

How do I get care after hours?  If you are in need of care after hours, please contact your PCP office and follow instructions on accessing care after hours. You may also call WOAH’s Nurse Access Line at 1-888-647-3627 which is available 24 hours a day.

Urgent Care is available after hours:

Bay Express Clinic in Coos Bay, 541-269-4499. They are open Monday through Thursday, 5:30 pm to 8:00 pm, and Saturday, 8:30 am to 12:00 pm.

North Bend Medical Center in Coos Bay can be reached at 541-266-1789 and is open 7:00 am to 7:00 pm, Monday through Friday, and 10:00 am to 3:00 pm on Saturdays.

Curry Medical Center in Brookings is open Monday through Saturday, 8:00 am to 8:00 pm, and can be reached at 541-412-2044.

Do I have co-pays for services or medications? Under WOAH CCO you do not have co-pays for services or certain medications. Mental Health medication may require a small co-pay.

Frequently Asked Questions about:

Applying for Health Coverage: http://www.oregon.gov/oha/healthplan/Pages/apply.aspx

Renew your Oregon Health Plan coverage: http://www.oregon.gov/oha/healthplan/Pages/reapply.aspx

OHP Benefits: http://www.oregon.gov/oha/healthplan/Pages/benefits.aspx

Coordinated Care Model: http://www.oregon.gov/oha/OHPB/Pages/health-reform/ccos.aspx

OHP & Taxes: http://www.oregon.gov/oha/healthplan/Pages/Tax-Info.aspx

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