Find a: Doctor Drug Search Shop Plans Members Employers Producers Providers Resources Careers Contact Us Log in Members Learn about my plan Questions about your health plan? Find answers here This page contains important information about PacificSource plans. You can also find answer to common questions at our FAQ page and of course, you're always welcome to contact us. What your plan covers In addition to the general information on this page, your PacificSource member handbook or policy provides coverage details specific to your plan. This information is also available any time through our secure member portal, InTouch for Members. You'll need to register when you use InTouch for the first time. All you need to register is a valid email address and either your member ID number (you'll find it on your ID card) or your Social Security number. Register for InTouch for Members How to get care After hours or emergency care Your member ID Benefits and services: what’s covered, what’s excluded Costs you may have to pay Reading your explanation of benefits (EOB) Find a doctor and information about doctors Find a specialist, behavioral health provider, or hospital Transitioning from a pediatrician to a PCP Out-of-area care and benefits Prescription drug and pharmacy information Premium Refund Out-of-network Liability and Balance Billing Manage your benefits and health online Access your personal benefit information with InTouch Learn more about your health with CaféWell Wellness programs, extra benefits, and discounts As a PacificSource member, you have access to wellness programs as part of your medical coverage, such as condition support, our 24-Hour NurseLine, tobacco cessation, and our prenatal program. Our members also have access to extra benefits and services, such as fitness center discounts, weight-management programs, and travel assistance. Learn more about wellness programs Our health plan programs How new technologies become covered services How to access personal health records How and why to get help from a Case Manager How to get support for a chronic condition Our Quality Improvement program and progress toward goals Our Utilization Management (UM) program Healthcare cost and quality The Healthcare Effectiveness Data and Information Set (HEDIS), is a tool used by more than 90% of America’s health insurers to measure things such as care and service. HEDIS makes it easier to compare plans on an apples-to-apples basis. In our HEDIS reporting, we used CAHPS survey results. CAHPS (Consumer Assessment of Healthcare Providers and Systems) is an initiative of the U.S. Department of Health and Human Services Agency for Research and Quality. It measures members’ satisfaction with PacificSource, and with physician and healthcare services. Our quality program highlights and progress (PDF) Read our HEDIS and CAHPS Report (PDF) Looking for information on the cost and quality of hospital care? Understanding prior authorization What is prior authorization (preauthorization)? How will I know if my upcoming procedure requires prior authorization? Do I need a prior authorization or referral for mental health care? How are prior authorization decisions made? Can I call in a prior authorization request? When can I expect my prior authorization to be completed? How will I be notified of the decision? What should I do if I have a claim that wasn't approved for payment due to "Preauthorization Required?" Our policy prohibiting financial incentives About insurance claims How to send us a claim Grace periods and claims pending Claims paid by other companies - coordination of benefits | third party liability Ending coverage and claim payments (retroactive claim denial) Your rights and services How to voice a complaint and your right of appeal Your right to independent, external appeals review Privacy: How we protect your personal health information Language assistance TTY assistance Your rights and responsibilities About Our Mission History Executive Team Board of Directors Company News Locations Community A Culture of Helping Not-for-Profit Status Investing in Our Communities Help Contact Us FAQ Glossary Careers Products Individual and Families Employers PacificSource Administrators Medicare Medicaid © 2021 PacificSource. All rights reserved. Non-discrimination notice | Security | JSON Files | Terms of Service | Privacy Policy