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PEBB FAQs

Did the Synergy/Summit network change?

The network name for Summit has changed to Synergy. New this year, Moda expanded our Synergy Network to cover all of Oregon. Starting Jan. 1, 2020, it includes all existing Synergy providers plus all providers who were previously part of the Summit Network. The expanded Synergy Network includes providers across the state, including Oregon Health and Science University (OHSU), Legacy Health and Adventist Health. The expanded network also covers providers in Washington and Idaho.

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Do I still need to select a Medical Home?

No. Members must now choose a PCP 360 for their primary care, instead of a Moda Medical Home.

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What is a PCP 360?

A PCP 360 is a high quality primary care provider (PCP) who is willing to partner with the member and be accountable for their health. They have met certain standards for safety and effectiveness, and will coordinated care with the member's other providers, as needed.

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Can I keep the primary care provider I am using today?

First, members will need to confirm that their current PCP is part of our Synergy Network and find out if they are a PCP 360. There is a directory of in-network PCP 360s on the Member´s Dashboard under Find Care. Members may also contact Moda Medical Customer Service at 866-923-0409 for help.

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Do I need a referral from my PCP 360 to see a specialist?

No. Members do not need a referral. PEBB's Moda Synergy plans do not require a referral in order to see a specialist, and you'll continue to pay your $10 copay for in-network specialist office visits.

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What happens if I don't see my selected PCP 360?

If your PCP 360 is unavailable, but a provider at the same location can see you, the benefit will be paid the same as your PCP 360 benefit. If you seek primary care services from an in-network provider who is not your chosen PCP 360 at a different clinic, then you will receive the OON benefit at 50% up to the maximum plan allowance. Members may be subject to balance billing, which is the difference between the maximum plan allowance and billed charges.

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Are Providence providers and facilities in the Synergy Network?

Providence providers and facilities in the Portland metro and Medford area are not in the Synergy Network. Only Providence St. Mary's facilities and specialists in the Walla Walla area are part of the Synergy Network.

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Are any Providence providers PCP 360s?

Members can choose their PCP 360 by logging in to their Member Dashboard account, or by calling Moda Medical Customer Service at 866-923-0409.

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How do I choose my PCP 360?

Members can choose their PCP 360 by logging in to their Member Dashboard account, or by calling Moda Medical Customer Service at 866-923-0409.

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Is massage therapy covered?

Effective 1/1/2020, massage therapy benefit is covered at a $10 copay (FT plan); $40 copay (PT plan), after the deductible has been met when a member sees an in-network licensed massage therapist.

  • All licensed massage therapists (LMTs) have their own National Provider Identifier (NPI) that indicates they are a licensed massage therapist. In-network providers will bill Moda directly. Members who see an out-of-network (OON) provider will most likely need to pay upfront and fill out a claims reimbursement form.
  • OON licensed massage therapy will be covered at the OON coinsurances (30% FT; 50% PT), and will be reimbursed up to the maximum plan allowance. Members may be subject to balance billing, which is the difference between the maximum plan allowance and billed charges.
    • For example, if a member went to Massage Envy and the massage was done by a licensed massage therapist, the benefit would be covered at the OON coinsurance. The member would then be reimbursed up to the maximum plan allowance.

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If my child is going to an out-of-state college, do they have to select a PCP 360?

Yes. Out-of-area dependents will need to select a PCP 360 for when they are in the service area (i.e., summer break or winter break), and while they are away. They will have access to the First Health Travel Network to receive in-network benefits when they are away at college.

Please contact your employer and Moda Customer Service to update their address with Moda Health.

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What are Virtual Visits?

Virtual Visits is a benefit that connects a member with a licensed OHSU doctor, physician assistant, or nurse practitioner on their computer or mobile device for urgent care services at NO COST SHARE.

To schedule a virtual visit, go to ohsu.edu/virtualvisits.

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

Together, we can be more, be better.

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