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Benefits Overview

Addiction & Mental Health Services

Dental Services

Vision Services


Addiction & Mental Health Services

The FamilyCare Mental Health Organization manages Oregon Health Plan benefits for members living in Clackamas, Multnomah and Washington Counties. Mental health and addiction services for adults, children and families are provided and include inpatient, outpatient and home-based services. Services are delivered through a broad network of community-based contracted providers. To access services, please refer to the list of providers in your member handbook. If you would like assistance in choosing a provider, please contact us at 503-345-5704 or toll-free at 800-458-9518.

If you are a FamilyCare member living outside this service area, please refer to your coverage letter for the name of the mental health organization providing your coverage.

For Members Seeking Services

How to Access Mental Health or Substance Abuse Treatment

Mental Health
There are a number of contracted mental health providers in the tri-county area. Please refer to the contracted provider list to specifically see what services are offered through each agency. Members are encouraged to call provider intake lines to schedule an intake appointment (no pre-authorization required for outpatient services with contracted providers). If you would like assistance in choosing a provider, or feel that more intensive services may be indicated, please contact us at 503-345-5704 or toll-free at 800-458-9518.

Substance Abuse Treatment
Detox and outpatient therapy are covered benefits that do not require pre-authorization when provided by a contracted provider. Please refer to the provider list for contracted agencies. If you would like assistance in choosing a provider, or feel that more intensive or long-term services may be indicated, please contact us at 503-345-5704 or toll-free at 800-458-9518.

Children's Mental Health System
Explanation of Levels of Care

Adult's Mental Health System
Explanation of Levels of Care

Assistance Programs

Chemical Dependency Benefits
Are you worried about your drug or alcohol use? If you said “Yes,” you have two options:

  1. Ask your primary care physician (PCP) for a referral.
  2. Self-refer to a drug or alcohol treatment center.

Three levels of treatment services are available. The level of treatment that you receive depends on an assessment that is done once you are seen by a treating clinician. The three levels of service for chemical dependency are:

  1. Outpatient – Can include both group and individual treatments.
  2. Intensive Outpatient – Can include both group and individual treatments on a more frequent basis.
  3. Medically Managed Inpatient – Admission into a hospital or treatment program until the physical conditions that accompany substance withdrawal have subsided.

If you have questions about your benefits, please call Navigation Services toll-free at 800-458-9518, Monday through Friday, 9 a.m. – 5 p.m. Admitting that you may have a problem with alcohol or drugs is the first step in seeking help!

For Treatment Providers

Integrated Services Array (ISA) Criteria

Services that require pre-authorization

  • Youth: Home-Based Services, Respite, Psychiatric Day Treatment Services (PDTS) Community Based Crisis Stabilization Services (CBCSS), Psychiatric Residential Treatment Services (PRTS), Subacute, Inpatient Hospitalization.
  • Adult: Intensive Outpatient, Respite, Intensive Case Management, Inpatient Hospitalization

Provider List and Community Resources*

Forms

* FamilyCare does not necessarily fund all services listed in community resource section.

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Dental Services

Your FamilyCare plan covers dental care services. Getting regular dental exams for preventive care is important for your overall health and can help prevent dental disease. Our members get connected to a dental care provider at one of these plans:

  • Access Dental Plan
  • Capitol Dental Care Inc.
  • Family Dental Plan
  • Managed Dental Care of Oregon
  • Willamette Dental Group
  • ODS Community Health

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Vision Services

FamilyCare believes that eye exams are an important part of preventive healthcare. Routine vision check-ups can determine if you need vision correction and may detect more serious conditions. Routine eye exams are covered for members 0 – 20 years old or pregnant.

Benefits for routine vision exams, eyeglasses and contact lenses are provided by Vision Service Plan (VSP). VSP providers are listed in the Provider & Pharmacy Directory, or you can search for VSP providers by location by clicking here.

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The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, co-payments and restrictions may apply. Benefits, formulary, pharmacy network, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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11/20/2013
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