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Will my insurance cover Legacy?

Will my insurance cover a visit to a Legacy Health doctor, clinic or hospital?

• First, thank you for seeking care at Legacy Health. We really appreciate it.

• The best thing you can do is to check with your health plan to see if your plan allows you to use Legacy providers, hospitals and services.

• Each health insurance plan has its own guidelines. Those guidelines can be very specific as to what is covered and by which provider.

• The good news is that Legacy is included in many insurance plans.

What happens if the Legacy provider or services I want are not covered?

• It might cost you. Most health plans require you to use only those doctors and hospitals in their networks.

• If you use a provider not in the network, you could wind up paying a big portion of the bill or all of it.

How can I use Legacy?

• Make sure your health plan includes Legacy.

• If Legacy is not part of your health plan, when you get the chance, choose a health plan that includes Legacy. If that is not an option, please ask your employer or health plan administrator to consider offering Legacy.

Where can I get more help?

• In Oregon, seniors can call the Senior Health Insurance Benefits Assistance Program (SHIBA) at 1-800-722-4134.

• In Washington, call the Statewide Health Insurance Benefits Assistance Program (SHIBA) at 1-800-562-6900.

What if I don’t have insurance?

• If you don’t have health insurance, you can likely get it as part of the Affordable Care Act. Legacy has patient advocates who will help you understand your health insurance options and apply.

• All you need to do is set up an appointment, and a patient advocate will meet with you individually. It’s free. Enrollment takes about two hours.
  • In Oregon, please call us at 503-413-2222 or 855-413-3998. 
  • In Washington, please call us at 360-487-3222 or 855-413-3998.

I need to choose a health plan. Any advice?

• When choosing a plan, you may want to ask:
  • Is your primary care provider in the network (contracted)?
  • Are the specialists whom you use now, or may likely use in the future (such as urologists, gastroenterologists, oncologists, cardiologists), in the network?
  • What are the extra benefits of the plan –– prescription benefits, gym memberships and more?
  • What is the coverage when you or a covered family member is out of the area, such as when traveling or in school?
  • What hospitals are in the network?
  • Are the items above likely to change at the next renewal? 
  • Will my prescriptions be covered?
  • What are the copay and deductible amounts?
For more tips on choosing a health plan, go here.

• Remember, to receive treatment at Legacy, you need to choose a health plan that has Legacy Health among its providers. We really appreciate it.