Many of our new, ACA-compliant individual and small group plans encourage members to select a primary care provider (PCP) when they enroll in the plan. Members pay a lower copay when they visit their designated PCP. Members pay a higher copay if they don't select a PCP or if they visit a different LifeWise provider or group. The split copay amounts are listed on the member's ID card. Providers need to confirm a member's eligibility and benefits in advance of the patient's visit to determine the correct copay.
Members can:
- Designate a unique PCP for every family member
- Change their PCP as often as they like
- Go to a specialist without a PCP referral
How to verify a member's PCP:
- Check the PCP's name and phone number online via our benefits and eligibility tool (if the member selected a PCP).
- Contact Customer Service by calling the number on the back of the card.
- If the PCP is incorrect, it is the member's responsibility to make the correction online through the member website or by calling customer service.
Types of PCPs:
- General Physician
- Internist
- Family Physician
- Naturopath
- Pediatrician
- Nurse Practitioner/ARNP
- Physician's Assistant
- Gynecologist
- Obstetrician
- Geriatrician
- Women's Health (for women, gynecologist services always result in a lower copay, including midwives)
Participating Providers
All contracted providers and facilities continue to be contracted for all LifeWise members, including those who purchase their coverage through Cover Oregon. Services provided to Exchange members will be reimbursed under existing contracts.