PacificSource Health Plans Insurance Review & Complaints: Health Insurance (2024)
PacificSource Health Plans provides health plans, along with group plans including dental insurance. PacificSource Health Plans are only available Oregon and Montana. PacicificSource Health Plans rates start at $320 a month for the Bronze standard plan and go up to $509 a month for the Gold standard plan.
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Ty Stewart
Licensed Insurance Agent
Ty Stewart is the founder and CEO of SimpleLifeInsure.com. He started researching and studying about life insurance when he got his first policy for his own family. He has been featured as a life insurance expert speaker at agent conventions and in top publications. As an independent licensed life insurance agent, he has helped clients nationwide to secure affordable coverage while making the...
Licensed Insurance Agent
UPDATED: Mar 8, 2024
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Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.
UPDATED: Mar 8, 2024
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
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Based in Oregon, PacificSource Health Plans provides health plan options to residents of that state as well as Montana and Idaho. They offer individual as well as group plans including dental insurance.
What is PacificSource Health Plans?
Physicians at Pacific Christian Hospital in Eugene, Oregon, founded PacificSource in 1933; within two years, the growing organization adopted the name Pacific Hospital Association (PHA). Operating in Lane County, the not-for-profit insured mostly government employees and wood product companies.
In the 1980s, PHA began to expand into surrounding counties, reaching statewide by the end of the 1990s. In 1994, the company changed its name to PacificSource Health Plans. In 2007, PacificSource expanded into Idaho and acquired Clear One Health Plans in 2010 to move into Montana as well. The company is also licensed in Washington State, although they do not currently offer health plans there.
PacificSource today offers a range of health plans for individuals and families while also continuing to offer coverage through employers. They have 272,000 members across their regional coverage area. PacificSource also writes Medicare Advantage and dental plans. Your one-stop online insurance guide. Get free quotes now! Secured with SHA-256 Encryption
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What coverage does PacificSource health plans offer?
PacificSource offers a range of PPO health plan options across three states; for the purpose of this review, we will take a look at the products offered in Oregon, where the company is based.
Plans are offered with two different networks, SmartChoice or Legacy Health, depending on the county in which the insured resides. The same four plan levels are offered in each network, with a standard plan at each level as well as several underlying options that require the applicant to meet specific requirements under the ACA. These cost-sharing plans can be purchased through the state healthcare marketplace.
Catastrophic
This plan is offered in either network with a deductible of $7,350, which is also the out-of-pocket maximum each year. Preventative care is not subject to the deductible, and this plan also covers three primary care visits per year at 100% before the deductible applies. After the deductible, all care is covered in full with no additional costs.
Bronze
The standard Bronze plan has an individual deductible of $6,650, doubled for families. Outside preventative care, all services are subject to the deductible and covered in full thereafter.
At this level, there is one cost-sharing plan available that is a $0 cost option, but as noted previously, this requires the applicant to qualify under ACA regulations.
Silver
The standard Silver plan has a $2,500 individual deductible, doubled for families. Primary care visits have a $40 copay, while specialist visits have an $80 copay. Prescription drug coverage starts with a $15 copay for Tier 1, and the deductible does not apply.
The Silver plan has a variety of options available to those who meet income and other requirements under ACA regulations, including a $0 cost-sharing plan. There are a total of five cost-sharing plan options.
Gold
PacificSource’s standard Gold plan has a $1,000 deductible per person, doubled to $2,000 per family. The co-pays with this plan are $20 for a primary care visit and $40 for a specialist. Tier 1 drugs under this plan start at a $10 copay, and the deductible does not apply.
PacificSource offers two cost-sharing plans at the Gold level, both of which have income and other requirements.
Dental Plans
Dental Advantage is available as a family plan as well as for kids only. This plan is a PPO with coverage both in and out-of-network, although out-of-network costs are higher.
Some services are covered in full, while others have a coinsurance of 20% or 50%. The per-person maximum per calendar year is $1,000.
Medicare Advantage
PacificSource offers Medicare Advantage plans that vary based on region. We pulled sample plans for the Portland, Oregon area.
Both plans are HMO plans, with the MyCareRx 31 offering $5 primary care visits and $35 specialist visits. The more expensive MyCare Rx 28 plan has the same copay for primary care, but a lower $25 copay for specialists, and lower co-pays in other areas.
Both plans include Part D prescription coverage. The Rx 31 starts at $3 for Tier 1. A deductible of $250 applies to Tiers 3, 4, and 5, but not the two lower tiers. The Rx 28 starts at $2 for Tier 1 and again has a deductible of $150 applying to Tiers 3, 4, and 5.
Both plans have the option to add dental coverage for an added premium.
PacificSource Advantage plans cover at least the same healthcare services as the original Medicare plus additional benefits, including gym membership, vision and hearing exams, 24-hour nurse line, and coverage for some over-the-counter medication.
Also, if you are on a PacificSource Medicare Advantage Plan, you can call them up and order a free Fitbit or Garmin watch to track your overall health and fitness.
Are the rates reasonable?
We ran a quote for plans in the Portland, Oregon area, using a 30-year-old male who is not a tobacco user.
The rates we returned started at $320 a month for the Bronze standard plan and went up to $509 a month for the Gold standard plan. Since these are local rates from a regional insurer, we are unable to accurately compare them to rates in other locations, but the rates appear to be on the high side based on what we have seen elsewhere. This includes our quotes from other regional insurers in Oregon, such as Providence Health Plan, which charges about $100 less for its bronze plan. It should be noted that coverage and network options are not apples to apples on these two plans, making the comparison only a general one.
The Medicare Advantage rates are readily available. The Rx 31 plan is $23 per month. These rates appear to be reasonable based on what we have seen for this type of coverage elsewhere, although again, we are unable to do a direct comparison with other locations.
PacificSource Health Plans Claims Processing Overview
Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)
PacificSource Health Plans offers multiple options for filing claims, ensuring flexibility and convenience for its policyholders. You can file a claim through their online portal, over the phone, or even via mobile apps. This variety of channels allows you to choose the method that best suits your preferences and needs.
Average Claim Processing Time
While specific claim processing times can vary depending on various factors, PacificSource Health Plans aims to provide efficient and timely claim processing. It’s advisable to contact their customer service or refer to your policy documents for more information on the average processing time for different types of claims.
Customer Feedback on Claim Resolutions and Payouts
Customer feedback is crucial in evaluating the effectiveness of an insurance company’s claim resolutions and payouts. PacificSource Health Plans has received feedback from policyholders, both positive and negative, regarding their experiences with claim resolutions.
It’s essential to review these testimonials and consider them when making an informed decision about your insurance provider.
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Exploring the Digital and Technological Aspects of PacificSource Health Plans
Mobile App Features and Functionality
PacificSource Health Plans offers a user-friendly mobile app with various features and functionalities. These may include accessing your policy information, checking claim status, finding in-network healthcare providers, and even submitting claims directly through the app. The app is designed to enhance your overall insurance experience.
Online Account Management Capabilities
Managing your insurance policy online has never been easier with PacificSource Health Plans. Their online account management capabilities allow you to review and update your policy details, view claim history, make premium payments, and access important documents, all from the comfort of your computer or mobile device.
Digital Tools and Resources
To empower their policyholders, PacificSource Health Plans provides a range of digital tools and resources. These tools may include health and wellness resources, cost estimation tools, prescription drug formularies, and educational materials to help you make informed healthcare decisions.
Exploring these digital resources can contribute to your overall well-being and satisfaction with your insurance coverage.
Are the ratings and consumer reviews positive?
PacificSource Health Plans has an A+ rating with the Better Business Bureau (BBB), with only four complaints on file in the past three years. Three of those have closed in the past 12 months.
On the company’s head office Facebook page there are 54 reviews, fairly evenly split between positive and negative, with 24 5-star reviews, 21 1-star reviews, and the rest in between for an overall 3.1-star rating. The reviews are quite detailed, with several negative reviews citing refusal to pay claims for personal health services and billing issues. Positive reviews are less detailed, some with only a star rating and no comment at all. The company seems to have attracted a very strong detractor, who claims the 5-star ratings are fake – there’s no evidence to back this claim.
PacificSource ratings from the National Committee for Quality Assurance for all three states are middling to poor. In Oregon and Idaho, the company has an overall 3.0 rating, and in Montana, the rating is lower at 2.5. The company generally received mid to low scores in all areas of customer satisfaction, with a few higher ratings in some categories.
The PacificSource Customer Service team remains available during business hours, Monday through Friday, from 8:00 a.m. to 5:00 p.m. As long as COVID-19 is a concern, PacificSource remains focused on how best to serve you.
Are video visits with a Primary Care Doctor online covered by PacificSource Health Plans?
Most insurers provide coverage for video visits at the same cost as in-person visits. You can choose your own primary care provider, and you have the freedom to see specialists without a referral.
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The Bottom Line
PacificSource offers a basic selection of health plans in three states, with a heavy focus on a wider selection of options for those that qualify for cost-sharing programs under the ACA. While the complaint volume isn’t alarmingly high, the detailed content of the Facebook complaints does raise some concern regarding the denial of claims. Although they might be worth comparing, most Oregon residents (and probably other states as well) who do not qualify for subsidies are likely to find lower premiums from other companies, either local or national.
Frequently Asked Questions
Does PacificSource Health Plans offer coverage for pre-existing conditions?
Yes, PacificSource Health Plans offers coverage for pre-existing conditions. Under the Affordable Care Act (ACA), insurance companies are required to cover pre-existing conditions without charging higher premiums or denying coverage.
Does PacificSource offer any wellness programs or discounts?
Yes, PacificSource offers wellness programs and discounts to promote healthy living. They may provide access to fitness centers, discounted gym memberships, wellness coaching, and incentives for participating in healthy activities.
Are prescription drugs covered by PacificSource health plans?
Yes, prescription drugs are covered under PacificSource health plans. The coverage may vary depending on the plan level and specific formulary. You can check the plan details or contact PacificSource to understand the prescription drug coverage options.
Can I add dental coverage to my PacificSource health plan?
Yes, PacificSource offers dental plans that can be added to your health plan. They have dental coverage options for individuals, families, and children. Dental plans may include coverage for preventive care, basic procedures, and major dental services.
Are there any limitations on choosing healthcare providers with PacificSource health plans?
PacificSource health plans provide flexibility in choosing healthcare providers. You can select your own primary care provider and see specialists without needing a referral. However, it’s important to check the provider network to ensure that your preferred providers are included.
What is the customer service availability of PacificSource Health Plans?
PacificSource’s customer service is available during business hours, Monday through Friday, from 8:00 a.m. to 5:00 p.m. They can assist you with questions regarding plan coverage, claims, billing, and general inquiries.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
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Ty Stewart
Licensed Insurance Agent
Ty Stewart is the founder and CEO of SimpleLifeInsure.com. He started researching and studying about life insurance when he got his first policy for his own family. He has been featured as a life insurance expert speaker at agent conventions and in top publications. As an independent licensed life insurance agent, he has helped clients nationwide to secure affordable coverage while making the...
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.