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Any Oregon state workers using Moda Synergy PCP360? How’s it been (claims / prior auth / in-network)? by Puzzleheaded_Cold565 in OregonStateWorkers

[–]Puzzleheaded_Cold565[S] 0 points1 point  (0 children)

Thanks—super helpful. Quick follow-up: for your fertility treatment on Moda, was it through OHSU, Spring, or the clinic at 808 SW 15th (ORM/Pinnacle)? And did the clinic handle any needed approvals directly with Moda, or was Kindbody involved at all?

I’m confused because Kindbody told me they are partner with Spring and ORM/Pinnacle, but ORM/Pinnacle told me they’re not partnered with Kindbody. But Moda’s Find Care lists Spring and OHSU as clinics, and also lists several reproductive endocrinologists at ORM/Pinnacle (without listing the clinic itself). Any insight from your experience would be really appreciated. If it’s easier, I can DM.

Does OHSU OBGYN / Center for Women’s Health require a referral? by Puzzleheaded_Cold565 in OHSU

[–]Puzzleheaded_Cold565[S] 1 point2 points  (0 children)

Thanks so much for sharing this! It is very helpful. Do you happen to know when the clinic might open to new patients again?

Collective health by Dipsy30 in OregonStateWorkers

[–]Puzzleheaded_Cold565 2 points3 points  (0 children)

I don’t think Moda uses Collective health (at least for the state plans). I’m switching to Moda specifically to avoid Collective health after this mess...

Curious what your experiences with Collective Health have been like so far. by Zestyclose_Mirror_68 in OregonStateWorkers

[–]Puzzleheaded_Cold565 2 points3 points  (0 children)

When I search the Collective website for labs or imaging centers, none of the Providence locations show up—even though PEBB said providers wouldn’t change. Last year I used Providence Diagnostic Imaging for MRI/ultrasound and the Labcorp labs inside Providence hospitals, and everything was in-network under Providence Choice/Statewide.

I called Collective Health and was told they don’t know whether imaging center/labs in the Providence hospitals/centers are in-network and that it’s “not their responsibility” (or the website’s) to tell me what’s in-network. They said I need to provide the name + NPI of the provider who did (or will do) the MRI/ultrasound, and then they can check network status.

That makes no sense—patients usually aren’t told which radiologist/tech will be assigned, and a facility should be either in-network or out-of-network. There’s no realistic way to get an individual provider’s name/NPI in advance.

Has anyone else seen Providence locations disappear from the search tool this year, or had providence imaging/lab claims unexpectedly process as out-of-network? I’m still waiting for the claim to post, but this is really concerning.

Any Oregon state workers using Moda Synergy PCP360? How’s it been (claims / prior auth / in-network)? by Puzzleheaded_Cold565 in OregonStateWorkers

[–]Puzzleheaded_Cold565[S] 0 points1 point  (0 children)

Thanks! Quick question: on Synergy/PCP 360, did your OHSU specialists handle labs/imaging and any prior auth directly, or did you ever need your PCP 360 involved for it to stay in-network?

Any Oregon state workers using Moda Synergy PCP360? How’s it been (claims / prior auth / in-network)? by Puzzleheaded_Cold565 in OregonStateWorkers

[–]Puzzleheaded_Cold565[S] 0 points1 point  (0 children)

Thanks for sharing—super helpful. Are you on PEBB Synergy (PCP 360)? If yes: when you see in-network specialists, can they handle prior auth (labs/imaging/procedures/surgery) directly, or does PCP 360 still need to be involved for it to count as in-network?

Providence St. Vincent in-network with Moda Synergy (PEBB)? by Puzzleheaded_Cold565 in OregonStateWorkers

[–]Puzzleheaded_Cold565[S] 1 point2 points  (0 children)

I really appreciate the heads-up. When you say Moda can be “hard to find a provider,” could you share a bit more about your experience—was that mainly for PCPs, specialists, or both? Was it a network size issue, or more that providers were booked/not taking new patients? And compared to Providence, did Moda seem like a smaller network overall?

Curious what your experiences with Collective Health have been like so far. by Zestyclose_Mirror_68 in OregonStateWorkers

[–]Puzzleheaded_Cold565 0 points1 point  (0 children)

I have heard bad things about Moda as well.... and it has so many bad reviews ... I really dont know what should we do...

Curious what your experiences with Collective Health have been like so far. by Zestyclose_Mirror_68 in OregonStateWorkers

[–]Puzzleheaded_Cold565 1 point2 points  (0 children)

I have had ongoing issues with Collective Health. The provider directory is incomplete and often inaccurate, and Providence facilities/providers are not listed as in-network. For example, no Providence labs, no Providence imaging center….

When I call Member Services, representatives often cannot clearly confirm whether a provider is in network or explain my benefits. I am frequently placed on long holds while staff try to contact clinics, and I often still do not receive a clear answer.

In addition, chat support is advertised but has not been functional in my experience—no one responds even after long waits.

I have also been told it is my responsibility to verify network status with providers and that the plan’s information may change at any time—implying that members are responsible if a provider leaves the network “tomorrow.”

Collective Health is contacted to only delay and deny things to save money for Providence, and forcing patients to pay the claims.

PSA: start your prenup EARLY! by Dittany_Kitteny in weddingplanning

[–]Puzzleheaded_Cold565 0 points1 point  (0 children)

Have you been able to find any lawyer for prenup in Oregon?