MAY I HELP YOU?
We invite you to call or visit us today: Samaritan Health Plans, 815 NW 9th Street, Corvallis OR 97330, M-F, 8 a.m. to 4:30 p.m.
(541) 768-5216
(866) 300-4100
Or, send us an email
FAQ's
- How do I maximize my benefits?
- How do I know if my providers are preferred or participating?
- Do I need a referral to see a specialist?
- Where do I get my drug prescriptions filled?
- What will my costs be for maternity care?
- More FAQ’s...
How do I maximize my benefits?
In order to maximize your benefits and keep your healthcare costs down, it is important to use preferred providers and to know your benefit plan. Your best benefit is available at the preferred benefit level.
How do I find out if my providers are preferred or participating?
You can call the Samaritan Choice Plans Member Services team for assistance at 1-866-300-4100 or (541) 768-5216.
Do I need a referral to see a specialist?
No, you do not need a referral to see a specialist, however, some services do need a preauthorization. To maximize your benefits you may want to see a preferred specialist.
Where do I get my drug prescriptions filled?
This plan covers medically necessary prescription drug services through a Samaritan Health Services pharmacy. The following is a list of the current participating Samaritan Health Services pharmacies:
Albany
- Elm Street Pharmacy, 812-5071, 812-5070 (24 hr. prescription refill)
M-F 8 a.m. to 6 p.m., Sat. 9 a.m. to 12 p.m. - Geary Street Pharmacy, 812-5544
M-F 9 a.m. to 7 p.m., Sat. 10 a.m. to 6 p.m.
Corvallis
- Samaritan Pharmacy Services at Good Samaritan Regional Medical Center
768-5225 or 768-5230
M-F 7 a.m. to 7 p.m., Sat. 9 a.m. to 1 p.m.
Lebanon
- Samaritan Lebanon Community Hospital Pharmacy, 451-7119
M-F 9 a.m. to 5 p.m., Sat. 9 a.m. to 4 p.m.
Newport
- Samaritan Pacific Community Hospital Pharmacy, 574-4740
M-F 9 a.m. to 5 p.m., Week-ends 9 a.m. to 3 p.m.
Lincoln City
- Samaritan North Lincoln Hospital Pharmacy, 996-7375
M-F 10 a.m. to 11 a.m. and 2 a.m. to 3 p.m.
If you are out of Lincoln, Linn or Benton Counties during an emergency situation, this plan covers prescription drugs received from any pharmacy. You or a family member must first pay the total cost of the prescription and then submit the receipt to Choice Claims Administrator for payment. Forms for submitting these claims are available at any Samaritan Health Services pharmacy.
Each claim is reviewed by the Administrator and evaluated to determine whether it qualifies for reimbursement based upon emergent use criteria. You will either be reimbursed as specified above or notified if the claim does not meet emergent use criteria.
If the out-of-pocket maximum has been reached or if you have double coverage through Samaritan Choice for prescription expenditures, an additional $30 co-pay will apply, per prescription, if the member does not use a drug in the lowest Tier that has a therapeutically equivalent drug available.
What will my costs be for maternity care?
For normal prenatal and postnatal office visits to a preferred provider, as well as standard ultrasounds and lab work, you will have one $15 co-pay. Your hospital stay for delivery at a preferred facility will be covered with a $100 co-pay per day with a maximum out-of-pocket cost of $500. Services not included in the standard maternity package will be paid as listed in your benefit plan. IMPORTANT: You will need to enroll your newborn within the first 31 days after birth. Contact Samaritan Choice Member Services for assistance.
Are diabetic supplies covered? Where do I get them?
Diabetic supplies such as test strips and lancets are covered with a 30% coinsurance when you use a preferred Durable Medical Equipment (DME) supplier. Supplies are sent to you from the DME supply company. They will contact your provider for you to obtain a copy of your prescription. Insulin and needles should be obtained at a Samaritan Health Services Pharmacy.
How does the outpatient mental health benefit work?
Choose any provider, keeping in mind that a preferred provider will maximize your benefits. After each tenth visit your provider will need to obtain an approved prior authorization to continue paying your claims. For more information on mental health benefits, contact Samaritan Choice Member Services for assistance.
What are my benefits for alternative care?
Samaritan Choice Plans does not cover alternative care services such as acupuncture, chiropractic, massage therapy, naturopathic, biofeedback, or hypnosis.
What is a Primary Care Provider (PCP) and why should I choose one?
To make certain you receive the best medical care and treatment, you should choose a PCP. This provider is a practitioner whom you trust, who will know and care about you, your health, habits, preferences, history and family. You may choose a PCP from the following specialties: Family Practice, Pediatrics, Internal Medicine, Obstetrics and Gynecology, and General Practices. If you are currently not established with a PCP, contact Samaritan Choice Member Services for assistance in finding a physician that will best meet your healthcare and is currently accepting new patients.
What procedures require a prior authorization? Why do I need to be concerned with this?
Procedures or equipment that require prior authorization are listed on page 45 of your benefit plan. The pre-authorization process helps you and your provider work together to determine the treatment that best meets your needs and confirms that the services will be covered by your plan. This helps prevent any unexpected costs to you.
What is the difference in coverage between the Samaritan Choice Benefit Plan and the Samaritan Choice High Deductible Plan?
Both plans cover the same services and have the same co-pays and/or coinsurance. The only difference between these two benefit options is the deductible that must be met before your healthcare services are paid for by the health plan. Click here to view your deductible information.
What constitutes preventative care?
Preventive care benefits cover annual routine physicals, routine gynecological exams, mammograms, routine immunizations and well child and baby exams. There is a co-pay for these services, however, the charge for these services (what your provider bills us) does not apply to your annual deductible.
Are preexisting conditions covered?
Samaritan Choice Plans has no waiting period or exclusions for preexisting conditions.
Are all immunizations covered?
Routine immunizations are considered preventive and are covered at 100% with $0 co-pay when services are provided by a preferred provider. Immunizations for the purpose of employment, travel, insurance or licensing are not a covered benefit.
How does dual coverage work?
It is important for you to notify both insurance companies if you or members of your family have double coverage. This allows coordination of benefits to take place. This is a method for determining which plan has the primary responsibility of benefits and which has secondary responsibility. We request this information be updated anytime there are changes to your coverage.
