PacificSource Customer Service — practical, expert guidance

Overview and what to expect

PacificSource Health Plans (founded in 1948, headquartered in Springfield, Oregon) is a regional insurer that administers commercial, Medicare and Medicaid products across parts of the Pacific Northwest. The company’s public website, https://www.pacificsource.com, is the primary hub for plan documents, provider directories and secure member portals. Understanding how PacificSource structures customer service — by product line (Individual & Family, Employer Groups, Medicare, and Government Programs) and by channel (phone, secure online messaging, mobile app, fax and in-person provider liaison) — will save time and reduce follow-up.

Customer-service interactions with PacificSource are transactional (claims, billing, authorizations) and adjudicative (appeals, grievances, medical necessity reviews). Each type has different documentation requirements and deadlines. Claim disputes and standard appeals typically follow industry-standard windows (see Prior Authorization and Appeals below) so assembling the right information up front avoids costly delays.

Primary contact channels and preparation

Start at the contact page on the official site (https://www.pacificsource.com/contact-us) to find the correct phone number and email address for your plan and state; PacificSource routes members to plan-specific teams rather than a single universal queue. If you are a member, the fastest phone route is the Member Services number printed on the front of your member ID card; for non-members or providers, the website lists provider relations and sales contacts. The company also provides secure online member portals and a mobile app for claims status, ID card downloads and payment — use secure messaging through the portal for non-urgent questions to create a documented thread.

When you call or message Customer Service, be ready with the following items: member name and date of birth, member ID number, plan name (e.g., “Commercial PPO 2025” or “Medicare Advantage HMO”), date(s) of service, provider name and NPI (if available), and a claim or authorization number. Having a clear, concise summary of the issue (what happened, when, and the resolution you seek) accelerates escalation and reduces transfer time.

Phone, online portal and mobile app practicalities

Typical phone hours for member services are business hours Monday–Friday (commonly 8:00 a.m.–6:00 p.m. local time), with emergency lines and Medicare lines sometimes staffed longer; confirm hours on the contact page. Expect initial phone wait times to vary by enrollment season — during open enrollment or major network changes, hold times can increase. If hold time exceeds 15–20 minutes, request a callback or use the portal secure message so the issue is documented and can be assigned to a specialist.

The online member portal displays claim status, Explanation of Benefits (EOB) documents, and secure messages. Use the portal to: view current premiums and payment methods, download ID cards, set up autopay, and initiate claim disputes. For providers, PacificSource’s provider portal allows batch claim submission and remittance advice; confirm portal URLs and login procedures on the contact page to avoid phishing risks.

What to have before you call — quick checklist

• Member ID number, full name, and date of birth (required for identity verification).
• Date(s) of service, provider name, clinic/facility address, and provider NPI or Tax ID.
• Claim or authorization numbers, exact denial reason codes or EOB excerpts (if challenging a claim).
• Supporting documents: medical records, itemized bills, referral authorizations, and prior authorization forms.
• Desired resolution and a timeline for follow-up (e.g., “I need a corrected claim by 30 days to avoid balance billing”).

Claims, billing, and payment mechanics

Claims processing follows the rules posted in your Evidence of Coverage (EOC) or provider manual. For most commercial plans, PacificSource processes clean claims within 30 calendar days after receipt; Medicare and state programs have statutory timeframes that the plan follows. When a claim is denied, the EOB will list an Adjustment Code and payer remarks — note those verbatim when discussing the issue with Customer Service or with a provider billing office.

Premiums and member cost-sharing (copays, coinsurance, deductibles) vary by plan year and county; for precise monthly premium figures, consult your plan’s rate sheet or the online account. Payment options typically include automatic bank draft (ACH), online credit/debit payment, mailed check, or phone-pay. If you are dealing with a past-due premium, ask Customer Service for a billing statement that shows the exact outstanding amount and an itemized ledger — this prevents duplicate payments and helps with reconciliation.

Prior authorization, utilization management and appeals

Prior authorization (PA) requirements are service- and plan-specific. Before scheduling elective procedures, verify PA requirements via the provider portal or by calling Provider Services; the authorization request should include diagnosis codes, planned CPT/HCPCS codes, and relevant clinical documentation (progress notes, imaging reports). Authorizations will include an authorization number and an expiration date — document both and keep copies of the authorization letter or fax confirmation.

Appeals and grievances have specific timelines: internal standard appeal decisions are commonly issued within 30 calendar days of receipt of the appeal; expedited/urgent appeals are often adjudicated within 72 hours when a delay would jeopardize life or health. If an internal appeal is denied, external review options (independent third-party review) are available — timelines and contact information are detailed in your EOC. Track appeal submission dates, reference numbers and the name of the reviewer or appeals coordinator assigned to your case.

Escalation path and regulatory options

If front-line Customer Service cannot resolve your issue, request escalation to a supervisor or to a dedicated case manager or resolution specialist. For clinical disputes, ask for review by the Medical Director or Utilization Review department. For ongoing balance-billing or denied emergency claims, ask Customer Service to provide the medical necessity justification in writing and to reopen the claim for reprocessing if appropriate.

If internal escalation is exhausted, state insurance regulators and external review entities offer independent recourse. For members in Oregon, Idaho or Montana, your state’s insurance division provides complaint submission forms and timelines — links and instructions are on PacificSource’s website and in your EOC. Keep a complete paper or digital file of all interactions (dates, names, ticket numbers, and copies of documents) to support regulatory complaints or external reviews.

Is PacificSource a PPO?

Like many health insurance companies, PacificSource offers PPO plans. Explore PacificSource Health Plans with HealthMarkets today!

Is PacificSource owned by United Healthcare?

PacifiCare Health Systems, Inc.
It was acquired by UnitedHealth Group in 2005.

What is the phone number for Pacific Life claims?

(855) 810-3301
With Pacific Life, you can start a claim with the guided online process in your portal or by calling us at (855) 810-3301.

How do I speak to Medicaid Customer Service?

★ Department of Health Care Services

1. California State Contacts.
2. Eligibility.
3. Enrollment.
4. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

Is PacificSource dental insurance?

PacificSource dental plans
We offer a variety of dental plan options in most of our service areas. You can combine dental with a medical plan, or purchase it separately.

What is the phone number for PacificSource provider?

888-224-3556
Washington State providers now have a new direct phone to reach PacificSource Provider Services: 888-224-3556, TTY: 711. We accept all relay calls. All Medicare Advantage claims with 2023 dates of service will be held while we validate correct pricing and benefits.