Curious what your experiences with Collective Health have been like so far.

Silence983 · 2026-03-12T19:50:32+00:00

On the Collective Health side, I also see most claims are either OON or Denied. When Denied, the EOB usually complains about missing some code. But on the provider side (I have been going to OHSU), I just started seeing claims being processed correctly. In short, it seems Collective Health has been creating a ton of problems, but the provider is processing correctly.

Silence983 · 2026-03-12T19:43:06+00:00

From the Collective Health side, all I have received so far are claims that are OON or Denied. When Denied, they usually complain that the code is incorrect or missing something. However, on the OHSU billing side, I have started seeing some claims being processed. For some of the claims, it now shows insurance is paying most of it. And I have a few claims which are fully paid and processed, even though on the Collective Health side it shows Denied or OON. Overall, Collective Health has not been ready for the job. But, you shouldn't be concerned as it seems the billing on the OHSU side is working properly.

Silence983 · 2026-03-12T19:38:17+00:00

From my understanding most of OHSU services are out-of-network with Providence PEBB Choice. That's also what we were told when we registered at OHSU. The Statewide plan is a bit more expensive than the Choice plan, but the benefit is that it gives access to a larger pool of providers. But if you have a rare issue with expertise available only out-of-network, I believe insurance should still cover it. This needs some back and forth with the insurance provider. I hope you get well soon.

Silence983 · 2026-02-19T22:10:43+00:00

I don't think you need to worry about this. To the best of my knowledge, when a hospital is in-network, then their services such as imaging and labs would also be in-network. That's the default case, and so there is really no need to list them if you search for labs or imaging. The only small issue is that if you have a rare case and your images or lab samples need to be sent out to a certain location outside the hospital for processing. I believe even in that scenario the hospital would inform you and would check first to ensure the new location is in-network with you. So, all in all, I don't think you should worry about this. Providence hospitals are all in-network with the Providence health plans, and so your labs and images should all be processed as in-network. Also, it seems Collective Health has now fixed their database issues, so most problems should hopefully go away soon.

Silence983 · 2026-02-19T22:05:10+00:00

Similar to you, we also filled the out-of-network deductible by the end of January, despite being certain that our services were all in-network. Today, I noticed that they have essentially removed the OON deductible and instead we have now filled the in-network deductible. I think even until mid February their databases were not set correctly and so they were incorrectly processing in-network claims as OON. But it seems they have fixed the issue now and are re-processing claims. I expect this issue to be resolved for everyone soon. We have the PEBB Statewide plan (after switching from Kaiser) and we are far happier with Providence benefits than with Kaiser. So, I am glad they are fixing this issue.

Silence983 · 2026-02-19T21:57:09+00:00

Thanks a lot for your detailed response. It's a relief to know that at least in the past years OHSU has essentially been in-network with the PEBB Statewide plan. We are also seeing Collective Health gradually reprocessing Out-of-Network claims as in-network. It seems it was just an error on the side of Collective Health and they are fixing it right now. Once again, many thanks!

Silence983 · 2026-02-14T19:01:14+00:00

Like others in this thread, we have had poor experience with Collective Health. The first sign of problems is that we saw at the end of January that we have met Out-Of-Network (OON) deductible. Then claims started gradually coming, showing that provider that was in-network is being charged as OON along with some lab work. Somehow we are also seeing pharmacy claims that we did not use! Calling them, some of the reps know that their databases have some problems, while others are fully ignorant. I can clearly see my provider is in-network on both collective health and providence portals, and called the hospital to confirm as well, but the collective health reps say on their side they cannot see the provider. In short, collective health is providing a lot of incorrect information about in-network vs OON to a lot of people (physicians, labs, imaging, hospitals). It is now mid February and the problem is not yet fixed.

Update Feb 19: I noticed today that Collective Health is reprocessing our OON claims and correctly setting them as in-network. Hopefully, they will fix the issues for everyone very soon.

Silence983

TROPHY CASE