2027 Insurance Contracting Updates

Valley Med wants patients to be informed when choosing health insurance coverage for 2027. Please review the following contracting updates carefully before selecting or changing your plan.

Public Employees’ Benefit Board Members

Valley Med is contracted with Moda Health, and our providers are considered in-network for PEBB members who select a Moda plan.

If you enroll in a Kaiser plan, Valley Med services will be considered out-of-network, and you will not be eligible for in-network benefits. Due to contracting limitations and Providence’s exit from PEBB, Moda is currently the only plan that provides in-network access to Valley Med.

Oregon Individual ACA Marketplace Plans

Four insurers will offer plans through Oregon’s individual Affordable Care Act marketplace in 2027. Valley Med is contracted with Moda Health and Regence BlueCross BlueShield of Oregon and is considered an in-network provider for those plans.

Valley Med is out-of-network with plans offered by Kaiser and BridgeSpan.

Atrio Medicare Advantage

Valley Med was unable to reach a mutually agreeable contract with Atrio Medicare Advantage and is not participating in that network.

Medicare Plans In-Network with Valley Med

Valley Med remains contracted and in-network with the following Medicare plans:

• Medicare Part B
• UnitedHealthcare
• AARP Medicare Plans from UnitedHealthcare
• Regence
• Moda Health
• PacificSource
• Wellcare
• Aetna
• Trillium

Third-Party Administrators (TPA)

Beginning in 2027, Valley Med will no longer submit claims directly to insurance plans that use the TPAs or networks listed below due to ongoing reimbursement and payment concerns. This change applies to:

• MultiPlan
• PHCS
• 6 Degrees
• C.A.S.
• Cigna Health and Life
• First Health

Patients covered by these TPAs or networks will receive a claim summary containing the information necessary to submit claims directly to their insurance plan for reimbursement.

Uninsured and Out-of-Network Patients

If you do not have insurance or choose to receive care using an out-of-network insurance plan, payment for services is due at the time of your visit. As a courtesy, Valley Med offers a 20% self-pay discount when payment is made in full at the time services are rendered.

Coming Soon: Direct Patient Care

Valley Med is developing a Direct Patient Care subscription option to provide patients with a more predictable and affordable way to access primary care. As insurance premiums and deductible amounts continue to increase, we want to offer another reasonable choice for patients and families.

How Direct Patient Care Works

Under a direct primary care model, providers do not bill traditional health insurance companies for office visits. Instead, patients pay a monthly, quarterly, or annual membership fee for access to covered primary care services.

The membership fee would cover most primary care services, including clinical visits, consultative services, care coordination, and comprehensive care management.

Because some services would not be covered under the subscription, patients are encouraged to maintain insurance coverage for emergencies, hospital care, specialty care, and other services outside of primary care.