PacificSource

My husband went on medicare in July. My pacificsource coverage was through him. Pacificsource had me enroll under myself July 1st and I had to meet another $4000 deductible, which I had already met the $4000 before July 1st. I ended up having a $8000 deductible plus paying coinsurance for last year. I appealed and my husband's employer contacted pacificsource, but since you appeal to them, of course they denied my appeal. I'm December the telehealth site was down, I was having breathing problems , so I called the nurse hotline number. She told me to go to the nearest ER right away. I did and then I ended up paying $924 to ER as pacificsource said that ER was out-of-network.

PacificSource claims to practice "trauma-informed" care. Ten years ago, I was traumatized by a severe adverse reaction to a prescription drug, and as a result, it is hard for me to try new medications. Sometimes I have to, for the sake of my health, but it's scary and difficult every time, and my mental health is always rocky for a while when I have to do it. I was on Vyvanse for ADHD for 7 years, and PacificSource happily covered it. Now that there are generics out, they wanted me to switch to generic lisdexamfetamine, since it's cheaper. Unfortunately, the generic did not work for me at all. My healthcare provider asked them to cover brand-name Vyvanse so I could get back to working effectively and move on with my life. PacificSource now says I have to try twelve other alternative drugs first before they will consider Vyvanse again. They are demanding that I dig up my old trauma repeatedly and risk my mental wellbeing to keep trying alternative drugs until I find something that's just as effective without any undesirable side effects. Ironically, there are more expensive drugs on that list of 12 that PS would cover without question. There is literally no logical reason that they can give us to not just cover the brand-name Vyvanse. Again, they covered this brand-name medication before-- all that has changed is that generics are out, and unfortunately, the generics don't work for me, which isn't even an unusual situation. Many insurance providers WOULD make this exception without a fight. PS, on the other hand, would literally rather pay to have me try a more expensive different drug than the brand-name of one that we already know works. My life has been falling apart as a result of this nonsense. PacificSource doesn't care at all. My healthcare providers have explained, over an over, why I need this specific medication. PacificSource doesn't listen. They lie, they plug their ears, they refuse to read facts you put in front of them, and they pretend that they need weeks or months to do simple things like read an email. It's not even about their bottom line-- it couldn't possibly be about money at this point. I suspect at this point that maybe someone's embarrassment about a mistake or prejudice toward ADHD people is what's holding this up. Because I'm disabled and poor and dependent on medicaid, I'm just stuck with them. They are incompetent at best and viciously ableist at worst.

Taking care of several covid patients I came down with covid also was unable to leave to go to the hospital these people are fabulous lady named April was so kind and help me out with so much information so that I was able to get care and so thankful for my Pacific source employee she was so kind and so informative and also had covid well helping me you rock April

PacificSource Health Plans was not a good insurance company for our family. I won't point out all of the flaws with the coverage, navigating their plans, finding a PCP actually taking new patients, denial of claims, etc. Those flaws are already well documented in other reviews. PacificSource Health Plans contacted us by mail admitting they made an error and paid a claim after we had left their insurance. The insurance company demanded our family reimburse the claim and resubmit to our current insurance company. Before we could get to all of this work caused by their error, PacificSource Health Plans sent us to collections. Holy batman. Summary: PacificSource Health Plans makes mistake, makes demands the customer fix it by jumping through a bunch of hoops, then puts customer in collections to try and fix their mistake.

I've had PacificSource for two years and the experience, customer service, and coverage had been mostly positive. In the last month that changed significantly. I searched for and found a specialty provider on their website. I called PacificSource to confirm that the provider was in network for me. When I spoke with the provider, they also informed me that they called to confirm network coverage. The customer rep had both of these calls documented. Found out a week ago that I am not in network and the only way I can avoid paying the just over $1000 fee to the provider is to file an appeal. I asked a manager if I have to spend my time doing that considering that PacSource made the mistake (which they sort of admitted). It's the only way I can avoid paying the provider so I have no choice. Bottom line: You can't trust what customer reps tell you and can wind up owing money even if you practice due diligence.

Honestly the worst insurance company I have had in my life. They really don't care about you, just the dollars. If you are in constant pain, grab some pain killers and booze. It will be 14 BUSINESS days before they will review your request. They are too busy enjoying their own lives and to hell with you.

I chose a dentist specifically from the list they provided for me and then denied $1200 claim because that dentist was out of network

They make decisions quickly and pay claims quickly.