Insurance & Medicare Information

insurance-information

Insurance

If you do not see your individual insurance plan listed below, please call our business office at 503.659.4777. We are currently unable to accept or provide medical care for Tri-Care members.

If you have any questions about insurance, please contact your insurance company directly, or our business office at 503.659.4777.

Northwest Primary Care accepts all major insurance plans, as well as most motor vehicle insurance and workers’ compensation carriers:

  • Aetna
  • Cigna
  • First Choice Health Network
  • Coventry/First Health Network
  • Health Net
  • Moda Health
  • United Healthcare
  • PacificSource Health Plans
  • Providence Health Plans
  • Regence Group Plans
  • Blue Cross HMA
  • Federal Blue Cross
  • Blue Cross PPO
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medicare-information

Medicare

The Plans we are accepting for 2022 are:

  • Providence Medicare Health Plans
  • Regence Blue Advantage HMO Plans
  • United Healthcare AARP Medicare Advantage HMO Plans
  • Pacific Source HMO Medicare Advantage Plans

We provide a variety of diagnostic and preventative services to our patients, many of which are covered by Medicare and Medicare Advantage.

Welcome to Medicare Visit
If you are covered by Medicare, you are eligible to receive a Welcome to Medicare Preventative Visit within your first 12 months of coverage. This visit includes a review of your health and counseling regarding preventative services, such as various health screenings, as well as vaccinations and referrals for other care as needed.

Yearly Wellness Visit
If you are covered by Medicare Advantage, you are eligible to receive a Yearly Wellness Visit. This visit is designed to help you and your care provider develop or update a personalized prevention plan based on your current health and risk factors.

Complete Physical Exam
If you are covered by Medicare Advantage, you are eligible to receive a complete physical exam from your care provider.

If you are covered by Medicare, you may also be eligible for additional preventative services. Some of these services include:

  • Flu Shots
  • Pneumococcal Vaccinations
  • Glaucoma Screening
  • Mammogram Screening
  • Prostate Cancer Screening
  • Abdominal Aortic Aneurysm Screening
  • Cardiovascular Screening
  • Colorectal Cancer Screening
  • Diabetes Screening
  • Diabetes Self-Management Training
  • HIV Screening
  • Pap, Breast, and Pelvic Exams
  • Bone Mass Measurement
  • Tobacco Cessation Counseling

For more detailed information regarding these services, please call your insurance company.

If you have additional questions regarding Medicare coverage, or would like help deciding which Medicare plan is best for you, please contact Willamette Valley Benefits by telephone at 503.659.5566, or visit their website.

Please call our Business Office at (503) 659-4777 for more information.

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Referrals

Our Referral Team will be happy to assist you with the referral process and to verify the proper paperwork has been submitted, as well as any questions you may have about referrals. If your insurance company requires a referral for non-urgent specialist visits, hospitalization, medical equipment, or other services, you must acquire a referral prior to receiving services. Separate referrals are usually required for follow-up visits, as well as diagnostic and surgical procedures, so check with your carrier before receiving these services.

Important Insurance Information

Your insurance plan determines which specialists and hospitals are in-plan. Since Northwest Primary Care does not make this determination, it is important that you contact your insurance carrier to verify that your referral is for an in-plan provider. This will ensure that you are not referred to an out-of-plan specialist or hospital, which could result in higher costs to you.

Frequently Asked Questions

We usually process non-emergency referral requests within 7 to 10 business days. If you have not heard from us regarding your referral within 10 days, please call our Referral Team at 503.353.1282, and we will be happy to assist you.

Our Referral Team or your insurance company will notify you by letter or telephone when your referral request has been approved.

You may schedule your appointment as soon as you receive notification that your referral request has been approved.

Referral Team Contact

12300 SE Mallard Way, Suite 160
Milwaukie, OR 97222
503.353.1282

Referral Team Hours

Our Referral Team is available Monday through Friday, from 8:00am to 5:00pm.

Our Mailing Address

Northwest Primary Care
PO Box 22075
Milwaukie, OR 97269

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Surecare

NWPC's Private Pay Option

Northwest Primary Care offers SureCare, discounted fees for office visits and services. Designed for patients who do not have insurance or request we do not bill their insurance company, SureCare provides the same quality care from our Primary Care Practitioners you’ve come to expect, with the benefit of discounted pricing.

How does SureCare work?

Simply request a SureCare visit when you make your appointment. Our scheduling department will let you know the discounted fee, based on your visit request. If additional services are recommended at the time of your visit (such as labs or x-rays), we will provide you with the discounted prices for those services, which you may choose to receive. By paying at the time of your visit, you’ll get the discount, paying a lot less than you would if we billed you.

Both basic and comprehensive visits are discounted. Conditions treated at a basic visit are things that generally end after an expected period of time, such as urinary tract infections, head colds, sprains, etc. Comprehensive visits treat chronic conditions, such as asthma, diabetes or high blood pressure, and multiple-care concerns.

Your Surecare Visit

Step One: Check In
Check in with our receptionist and pay the discounted office visit charge, which is based on the condition for which you are being seen.

Step Two: Fee Ticket
The receptionist will give you a Fee Ticket listing the cost of additional lab, radiology or other services that your Primary Care Practitioner may need to order in the exam room based on your medical condition or needs.

Step Three: Visit
Visit with your Primary Care provider, who will discuss your medical needs. They may recommend additional services, such as labs and/or radiology.

Step Four: Additional Services
Decide if you want these additional services and if so, accept the services. Your Fee Ticket will be marked by the department providing the service.

Step Five: Return Fee Ticket
Once you have completed your visit and additional services (if any), return the Fee Ticket to the receptionist, who will determine the total cost for these services.

Step Six: Pay your bill
If you pay your bill before you leave the clinic, you will receive the discount. If you do not pay before you leave the clinic, you will be billed for the full cost of the additional services you received. When you receive this bill, it is due and payable upon receipt.

Fee Schedule

Payment is due at time of service.

  • Basic Office Visit: $185
  • Comprehensive Visit: $225
  • Lacerations/Foreign Body Removal: $246

Please Note: Under State of Oregon regulations, we are not allowed to offer this program to patients being seen for established Workers’ Compensation claims. For SureCare visits, we accept payment by cash, VISA, MasterCard, Discover and personal check.

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