Providence Health Plan Insurance Review & Complaints: Health Insurance (2024)

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Connected with the Providence medical centers in the Pacific Northwest, Providence Health Plan offers a range of individual and family coverage options for health insurance. They cover members in specific parts of Oregon, including the city of Portland.

Our Providence Health Plan review will cover Providence Health Plan rates, how to get Providence Health Plan quotes, and what type of plans they offer.

If you want to compare your options as you read through our Providence Health Plan insurance review, enter your ZIP code now.

Who is Providence Health Plan?

Providence has a long history that goes back to a Catholic mission in Quebec, Canada founded in 1843. The first Sisters of Providence arrived in the Pacific Northwest in 1856 and established the area’s first permanent hospital. Incorporated in 1859, the company began spreading up and down the coast, building more hospitals and medical centers.

Providence first offered health insurance coverage as a Health Maintenance Organization (HMO) based out of their two major hospitals located in Portland, Oregon. By 1997 they had expanded and merged two separate healthcare plans to form Providence Health Plan, which offers mainly PPO plans, a move away from the original HMO model.

At this time, Providence Health Plan of Oregon offers their individual and family and Providence Medicare Advantage plans to members in the northwest counties of Oregon, although medical services are offered in other locations. They have a wide variety of plans to choose from. Coverage can be purchased directly online or over the phone. All of these methods can help you find the best overall Medicare company for your family.

What Providence Health Plan products are there to choose from?

Providence has a good selection of individual and family plans, some with nationwide networks and some with smaller networks.

Balance Plans

The Balance plans have a nationwide PPO network and cover both in and out-of-network providers. There are two choices available: Silver and Bronze.

The Balance 2500 Silver has a $2,500 individual deductible and $5,000 family deductible for in-network provider care. Outside the provider network, deductibles are much higher, $10,000 for an individual and $20,000 for a family. Co-pays are $25 for primary care and $50 for specialists in-network. Out-of-network care is covered at 50% coinsurance. Prescription drugs start at a $20 co-pay for Tier 1.

The Balance 7150 Bronze plan has in-network deductibles of $7,150 for an individual and $14,300 for a family. Out-of-network deductibles are extremely high, at $28,600 for an individual and $57,200 for a family. In-network primary care provider visits have a $50 copay, and there is no copay for specialist visits. Primary care and specialist visits out-of-network are covered at 100% after the deductible is met. Prescription drug coverage starts at $30 for Tier 1.

Choice Plans

The Choice plans are also PPO, but have a smaller in-network region, covering most counties in Oregon. Out-of-network care is available with a higher coinsurance and higher deductible. Like the Balance, there are two levels with the same deductibles.

The Choice 2500 Silver has the same deductibles and the same co-pays as the 2500 Balance plan, while the Choice 7150 Bronze matches the deductibles and coverage levels of 7150 Bronze. Prescription drug coverage is the same as the Balance plans. Unlike the Balance plan, however, out-of-network care has a 50% coinsurance after the deductible is met.

The major difference between these plans is the more limited coverage area for in-network care, which should equate to a lower premium.

Connect Plans

Connect plans again come with the same two levels of care and the same deductible choices. These plans are meant for people within the Portland metro area and cover only Multnomah, Clackamas, and Washington counties for in-network providers. As a PPO plan, however, out-of-network coverage is available.

Basic co-pays and prescription drug coverage for the Connect 2500 and 7150 plans are the same as the Choice plans. Again, due to the more limited coverage area, we would expect premiums to be lower for these plans.

Standard Plans

These plans meet the State of Oregon’s outlined standards for Gold, Silver, and Bronze levels of coverage. These plans provide an extensive network, spanning nationwide.

The Standard Gold plan has a $1,000 individual in-network and $2,000 family deductible. Out-of-network deductibles are $4,000 for an individual and $8,000 for a family. The primary care copay is $20, and specialists are $40, in-network. Out-of-network visits have a 50% coinsurance amount. Prescription drugs start at $10 for Tier 1.

The Standard Silver plan has in-network deductibles of $2,500 individual and $5,000 family, while out-of-network deductibles are $10,000 individual and $20,000 family. In-network co-pays are $35 for primary care and $70 for a specialist visit, and again the out-of-network coinsurance is 50%. Prescription drugs start at $15.

The Standard Bronze plan carries a $7,150 in-network individual deductible, while the family deductible is $14,300. Like the other 7150 plans, the out-of-network deductible amount skyrockets to $28,000 for an individual and $57,200 for a family. With this plan, out-of-network care is again covered at 100% after the deductible is met. Prescription drug coverage starts at $35 for Tier 1 drugs.

HSA Qualified Plans

Providence has two HSA (Health Savings Account) Qualified options at the Silver and Bronze levels. These plans have a nationwide network and allow members to save pre-tax dollars in an HSA account to use towards any out-of-pocket cost they expect to pay.

The 2800 Silver plan has an individual deductible of $2,800 for network care, and the family deductible is $5,600. The out-of- network deductibles are $11,200 for an individual and $22,400 for a family. All in-network office visits carry a 20% coinsurance, while out of network the coinsurance amount is 50%. Similarly, prescription drugs are covered with a 20% coinsurance.

The 6000 Bronze plan has a $6,000 individual deductible in-network, and a $12,000 family deductible. Out-of-network deductibles are $24,000 for an individual and $48,000 for a family. The coinsurance amounts, both out-of-network, and in-network, are the same, as is the prescription drug coverage.

Providence Progressive Dental Plan

The dental coverage plan can be added to any Providence Health Plan that is purchased directly from the company but cannot be purchased as an individual insurance product.

There is a low $25 individual deductible, and $75 family for in-network dental care. Out-of-network deductibles are doubled. The plan includes full coverage for all preventative care, and a range of coinsurance amounts for other services.

Medicare Advantage Plans

Providence has a good selection of Oregon Medicare Advantage plans that vary based on the county. Most plans are available with or without added Part D prescription drug coverage.

It’s also important to understand what Medicare covers when signing up for a plan. Does Medicare cover Cialis? Medicare Plan D covers most prescription drugs, but it might not cover drugs like Cialis.

The Providence Medicare Extra is an HMO plan that has no deductibles. Primary care visits cost $10 and specialist visits cost $15. If you choose the option that includes Rx coverage, co-pays start at $6.

The Providence Medicare Choice plan is an HMO-POS plan. Again, there is no deductible with this plan, and co-pays are $15 for primary care and $30 for specialists. Like the Extra plan, prescription drug benefits, if added, start at $6.

The Providence Medicare Prime plan is a $0 premium (after regular Medicare premiums) option that includes Part D coverage. Although there is no medical care deductible, this plan does have a $200 prescription drug deductible. Prescription co-pays begin at $7 for Tier 1.

The Providence Medicare Compass plan includes Part D coverage as well, but does have a premium. There is no medical deductible and a $100 prescription deductible. Primary care co-pays are $15, and specialist visits $45. Prescription drug coverage starts with a $10 copay for Tier 1 drugs.

Providence Medicare Dual Plus is an HMO-SNP plan. It is also a $0 premium plan, the second offered by Providence. There is no deductible for in-network care, no copay for any office visits, and Tier 1 drugs start at $0.

Providence Medicare Latitude is an HMO-POS plan with no medical deductible and a $100 prescription deductible. Co-pays for in- network care are $15 for primary and $45 for specialist. After the deductible, prescription drug co-pays start at $10.

Providence also has add-on dental and vision benefits to enhance the coverage offered in any of the Medicare plans.

The annual cost estimate for a plan includes covered annual monthly premiums and any annual cost sharing expenses that you must pay out-of-pocket for the medications entered.

What are the key benefits of choosing a Medicare Supplement plan?

Choice Choose any hospital, doctor, or specialist that accepts Medicare without network restrictions. Peace of mind As long as you pay your plan premiums on time, you are guaranteed coverage for life.

Does Providence Health Cover Addiction Treatment?

Providence Health does cover addiction treatment at similar levels as treatment for other health conditions. In emergency situations, care will be provided. For non-emergency situations, prior authorization may be required before treatment can be received, depending on the circumstances and your coverage.7 As part of its substance abuse treatment, Providence Health provides a spectrum of care, including:8,9 Detoxification. The initial step for individuals with a chemical dependency, detoxification is typically conducted in a medically managed setting with 24-hour medical supervision, where doctors may prescribe medications as needed to ensure safety and comfort while an individual’s body clears itself of drugs and alcohol.

Are Providence Health Plan rates competitive?

There are a lot of plans to select from at Providence, and rates vary based on the county of residence as well as the number of people being added to the plan. There is a very easy-to-use rate calculator.

To get a sample rate, we selected a single, 30-year-old, non-smoker living in Multnomah County. The lowest rate we returned was $215 a month for the HAS Qualified 6000 Bronze plan. The most expensive was the Standard Gold plan at $382 a month.

Providence lists all the Medicare Advantage rates on the website as well, along with each summary of benefits. As mentioned, there are two plans available with no additional premium above the regular Medicare rate. Rates vary from there.

Providence charges increased family rates for up to three children; after three, there is no additional premium.

Providence Health Plan Claims Process

Ease of Filing a Claim

Providence Health Plan offers multiple convenient methods for filing a claim. Policyholders can file claims online through the company’s website, over the phone by contacting their customer service, or by using the mobile app provided by Providence Health Plan.

This flexibility ensures that customers can choose the most convenient option for their needs.

Average Claim Processing Time

The average claim processing time with Providence Health Plan is not specified in the provided information. Customers may want to inquire about the typical processing time when filing a claim to have a better understanding of what to expect in terms of reimbursement.

Customer Feedback on Claim Resolutions and Payouts

The information does not include specific customer feedback regarding claim resolutions and payouts. To assess customer satisfaction with the claim process, it is advisable to consult online reviews and customer testimonials or contact Providence Health Plan directly for more information.

Providence Health Plan Digital and Technological Features

Mobile App Features and Functionality

Providence Health Plan offers a mobile app that policyholders can use for various purposes related to their insurance coverage. The exact features and functionality of the mobile app are not detailed in the provided content.

To explore the capabilities of the app, customers can download and install it on their mobile devices.

Online Account Management Capabilities

Providence Health Plan provides online account management capabilities, allowing policyholders to access their accounts, view policy details, make premium payments, and track claims online. These online tools make it convenient for customers to manage their insurance policies and stay informed about their coverage.

Digital Tools and Resources

The content does not specify the digital tools and resources offered by Providence Health Plan. However, insurance providers typically offer resources such as educational materials, FAQs, and online calculators to assist policyholders in understanding their coverage and making informed decisions.

Customers can explore the company’s website to access these resources.

What do the ratings and consumer reviews say?

Providence Health Plans has an A+ rating with the Better Business Bureau (BBB). There have been only two complaints on file in the past three years and none in the past 12 months. There is one review on the BBB site that is negative but appears to be focused more on Providence Medical Center than on the health insurance plan itself.

The review did point out one thing worth noting – that as a Catholic institution, Providence’s stance on health care may be impacted by the belief system of the founding faith.

In our search for reviews of this company, we found very little directly relating to the health plans, coverage, and service. This is not unusual for a local health plan like Providence.

The National Committee for Quality Assurance gives Providence a 3.5 overall, with a lower score of 2.5 in consumer satisfaction. The company performed particularly poorly in areas scoring Providence providers. However, as most of the plans are PPO plans with a fairly large network, this experience may vary widely outside of Providence clinics.

Given the low complaint volume overall, Providence appears to have a fairly good reputation.

What is the bottom line?

Providence is one of the largest local insurance providers in the Portland, Oregon area and has a really impressive array of available plans at various price points. Their very high out-of-network deductibles give the impression that they lean heavily on ensuring members use in-network services, although these do appear to be extensive. Providence will likely be a good fit for those who live within the main service area and do not anticipate a lot of out-of-network care needs.

Now that you have read the full Providence Health Plan insurance review, find out how much you could save on health insurance. Enter your ZIP code to compare quotes.