Frequently Asked Questions

Our system matches new members with PCPs in the area they live. If you already have an established relationship with a PCP that is contracted with us, just give us a call. We’re more than happy to update our records.

Medicare members, American Indian and Alaska Native members can join, change or leave their CCO anytime. 

All other members can change at these times as long as there is another open CCO in their area: 

• If you are new to the Oregon Health Plan, during the first 90 days after you enroll  
• If you have been on OHP before, during the first 30 days after you enroll in a CCO  
• If you move to a place that your CCO doesn’t serve, as soon as you tell OHP Customer Service about the move ` When you renew your OHP coverage (usually once each year) 
• If you have an important OHP-approved medical reason  
• For any other reason, one time each year. 

For Medicare members, the change will happen as soon as OHA approves it. For all other members, it will happen at the end of that month. 

Note: Only some parts of Oregon have more than one CCO. This means you can’t change CCOs in most counties.

To change CCOs for any other reason or to leave your CCO, call Client Services at 1-800-273-0557.

If you have Private health insurance: you do not need to be in a CCO. Your insurance will manage your health care. Report your insurance at http://www.ReportTPL.org

If you are in a CCO but want to receive services as a Fee For Service member:
OHP want you to get managed health care from a CCO. CCOs are designed to make sure you receive the best possible care within your community. CCO’s can provide and cover some services that OHP cannot. But you can change to Fee-for-service (FFS) OHP at any time if:

• You are an American Indian or Alaska Native
• You are also on Medicare in addition to OHP or
• First, call your CCO and ask for help. You may not need to be in fee-for-service OHP to get the help you need.
  • If your CCO can’t help, call OHP Client Services. Staff will mail you a Request for Temporary Fee-for-Service Coverage form (OHP 416) to complete. 
  • Give the form to your primary care provider. Your provider will fill out the form and ask OHA to approve giving you fee-for-service OHP.

Being removed from your CCO

Your CCO may ask OHA to remove you if you: 

• Are abusive to CCO staff or your providers or ` 
• Commit fraud, such as letting someone else use your health care benefits

Dual-Eligible Members

As of July1, 2019, the Dual-Eligible members will be auto enrolled into the CCO and will have to ask for Fee For Service if they want to top out. Dual-Eligible is individuals who are on Medicare and eligible for Medicaid.

Yamhill Community Care provides a different way of delivering care to OHP members. By working within the community, Yamhill CCO:

• Integrates physical, mental and dental health services
• Brings new models of care that are patient‐centered and team‐focused
• Is local enough to be relevant and large enough to be financially sustainable
• Is locally governed by a partnership among local health care providers and community members
• Has a Community Advisory Council (CAC) that helps look at the community’s health care needs and recommends transformative changes

Members can call Yamhill CCO Customer Service toll-free at 1‐855‐722‐8205. TTY/TDD callers can dial 1‐800‐735‐2900 or 7-1-1.

For questions to the state about CCOs, members can call 1‐855‐226‐6170 or go to
www.oregon.gov/OHA/healthplan.

Yamhill Community Care works closely with the following organizations in the community:

• Willamette Valley Medical Center
• Physician’s Medical Center
• Providence Newberg Medical Center
• Yamhill County Health & Human Services
• Virginia Garcia Memorial Health Center
• Lutheran Community Services NW
• Providence Medical Group
• McMinnville Physicians Organization
• Capitol Dental Care
• Other local physicians and health providers

Yamhill Community Care has a Community Advisory Council (CAC), which is made up of members, health care providers, representatives from the community, and representatives from county government. The job of the CAC is to ensure that the health care needs of the community are being addressed.

To change your PCP, call YCCO Customer Service at 855-722-8205. We are happy to help you find a new PCP.

To change your dentist or mental health provider, you’ll need to call their customer service phone number(s) located on the back of your YCCO ID Card.

If you and your PCP decide that you should see a specialist, your PCP will give you a referral. See the section “Referrals to other providers and direct access to specialists” in your handbook for more information. You can also call Customer Service

Contracted providers can be found using our online provider search on our website. You can call and ask which hospitals your OB/GYN works with. If you do not have internet access, or just prefer to call us for the information, we will be glad to help you.

Please call OHP Customer Service at 800-699-9075 and let them know what has changed. If you have a DHS caseworker, please call them instead of calling OHP. You can find more information in the section “Changing your address or phone number” in your handbook. 

YCCO maintains a list of covered drugs called a formulary. Please talk with your doctor about the medications you need. Your doctor may need to submit a prior authorization or may need to make a change to a covered drug. (We do not cover Mental Health drugs. Mental Health drugs are covered by the OHP and not your CCO. Your pharmacy will bill these medications to the OHP.) If you are a new member and are unable to fill a medication prescription, you may qualify for a transition supply. Please call us to find out if you qualify, the telephone number is 

If you are experiencing a mental health crisis or emergency, get help right away and do not wait until there is a real danger. Call the crisis hotline in your county, call 911, or go to the emergency room. There is also more about getting help for a mental health crisis in your handbook in the “Mental Health Services” section. 

Yamhill County

844-842-8200

Polk County

503-623-9289

503-581-5535*
(*After hours, Weekends & Holidays)

Washington County 
503-291-9111

When you go to the hospital or the emergency room, you may be treated by a provider who doesn’t work for the hospital. For example, the emergency room doctors may have their own practice and provide services in the emergency room. They may send you a separate bill. If you have surgery in a hospital, there will be a separate bill for the hospital, the surgeon, and maybe even the lab, the radiologist, and the anesthesiologist. Just because the hospital has been paid by OHP, it doesn’t mean that the other providers were paid by OHP. Do not ignore bills from people who treated you in the hospital. If you get other bills, call each provider and ask them to bill your CCO. See the section “OHP members don’t pay bills for covered services,” in your handbook for more information.

Don’t pay the bill. See the section “OHP members don’t pay bills for covered services,” in your handbook for more information.

You may have to pay for services:

1. 1. If you see a provider that does not take OHP or is not part of our provider network
   2. If you weren’t eligible for OHP when you received the service
   3. If you sign a detailed Agreement to Pay for that specific service that OHP doesn’t cover