Know what a visit costs before you come in.
We take most Oregon plans, including the Oregon Health Plan. Here is what your plan usually pays for, what you might owe, and who answers when a bill does not make sense.
- In network with most Oregon plans
- Oregon Health Plan welcome
- A billing manager you can reach by name
Plans we take
We are in network with the plans in this table. Networks are set plan by plan, not company by company, so the name on the card is only half the answer. Call with your member ID and we will check your exact plan while you are on the phone.
On OHP? Your child needs Sagebrook listed as their primary care provider. Choose or change it with PacificSource Community Solutions at 800-431-4135, or call us and we will do it with you on the line.
Not on the list? Call anyway. Some plans pay for out-of-network visits, and we can tell you roughly what one would cost before you decide.
| Plan | Notes |
|---|---|
| Regence BlueCross BlueShield of Oregon | Employer and Marketplace plans |
| PacificSource Health Plans | Employer and Marketplace plans |
| Oregon Health Plan (OHP) | Through PacificSource Community Solutions, Central Oregon’s coordinated care organization. Healthier Oregon (Cover All Kids) members move to OHP Open Card in January 2027. We accept Open Card too. |
| Providence Health Plan | Employer and Marketplace plans |
| Moda Health | Employer and Marketplace plans |
| Aetna, Cigna, UnitedHealthcare | Most employer plans |
| TRICARE | For military families |
What a visit usually costs you
Most plans must cover preventive care for children in full when the provider is in network. That is federal law under the Affordable Care Act. Visits for a problem are different: your copay, deductible or coinsurance applies.
| Visit | What you usually pay | Why |
|---|---|---|
| Well-child checkup | Nothing, with most plans | Preventive care, covered in full in network |
| Vaccines on the recommended schedule | Nothing, with most plans | Also preventive care |
| Sick or injury visit | Your copay, or it counts toward your deductible | Set by your plan |
| A checkup where we also treat a problem | Nothing for the checkup, your copay for the problem | Two services, billed separately |
| Tests sent to an outside lab | The lab bills you directly | Ask us to use a lab in your network |
| Any covered visit on OHP | Nothing | OHP has no copays for covered services |
A few plans, mostly older “grandfathered” ones, do not have to follow the preventive-care rule. The member services number on your card can tell you. Source: HealthCare.gov, preventive care for children.
Why a checkup can come with a bill
A checkup covers growth, development, the exam and vaccines. If we also look into a new or ongoing problem, such as ear pain, an asthma flare or a medication check, insurance rules count that as a second visit, and your copay or deductible can apply to it.
We will say so before we go further, so you can choose to deal with it today or book it separately.
“Once a year” means different things
Some plans cover one checkup per calendar year. Others want 365 days between them, and a checkup a week early is not covered.
We check the date against your plan when you book.
If you have no insurance, or would rather pay yourself
You are entitled to a Good Faith Estimate: a written list of what we expect to charge, before the visit. It is a federal right under the No Surprises Act.
| When | Your estimate arrives within |
|---|---|
| You book at least 3 business days ahead | 1 business day of booking |
| You book at least 10 business days ahead | 3 business days of booking |
| You ask for one without booking | 3 business days of asking |
If the bill comes in at least $400 above the estimate, you can dispute it within 120 days of the date on the bill. The federal No Surprises Help Desk answers at 1-800-985-3059, or see cms.gov/nosurprises.
Your child may qualify for OHP. In Oregon, children under 19 can get the Oregon Health Plan in households earning up to 305% of the federal poverty level, whatever their immigration status. There are no premiums and no copays.
Apply online through the Oregon Health Authority, or call ONE Customer Service at 1-800-699-9075.
Vaccines. Uninsured children get the vaccines themselves at no charge through the federal Vaccines for Children program, which we take part in.
How a bill reaches you
Your plan sends an Explanation of Benefits
It shows what was billed, what the plan paid and what you may owe. It is not a bill. Keep it until our statement arrives.
We send a statement for what is left
Once your plan has processed the claim. Each service is listed by date, so you can match it to the Explanation of Benefits.
Pay, or ask about a plan
Card, HSA or FSA card, or check: by phone or at the front desk. If the total is more than you can manage at once, ask about a payment plan.
Copays are collected at check-in. If a statement does not match your Explanation of Benefits, call before you pay. Mistakes happen, and we would rather fix one than collect it.
Adding a new baby to your insurance
A newborn is not added to your plan automatically, and most plans give you a short window to do it. Miss it, and your baby may be uninsured until the next open enrollment.
| Your coverage | Add your baby within | Then |
|---|---|---|
| Employer plan | 30 days of the birth | Coverage starts from the day your baby was born |
| Marketplace plan (HealthCare.gov) | 60 days of the birth | Coverage starts from the day your baby was born |
| Oregon Health Plan | As soon as you can: call ONE Customer Service at 800-699-9075 | Your baby stays covered until their sixth birthday |
Until your baby has a member ID, bring your own card to the first visit. We hold the claim until the baby is added. More on the first newborn visit.
Talk to a person who can fix it.
Colleen Byrd runs billing here. She can explain a statement line by line, correct a claim, set up a payment plan or put an estimate in writing. Weekdays, by phone or email.