Coverage Decisions for Medical Care or Part D Prescription Drugs

A coverage decision is a decision we make about your benefits and coverage, or about the amount we will pay for your medical services or drugs. We are making a coverage decision for you whenever we decide what is covered for you and how much we pay. In some cases, we may decide a service or drug is not covered or is no longer covered by Medicare for you. If you disagree with this coverage decision, you can make an appeal. Please see the section about appeals.

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Fax Us

For Medical Coverage Decisions:
541-382-2952

For Prescription Coverage Decisions:
541-330-2528
800-366-4873 Toll-free

Providers: Please submit medication authorizations through InTouch , our secure web portal.

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For Medical Coverage Decisions:

For Prescription Coverage Decisions:

For general questions about your Prescription Drug Coverage OR to initiate a Coverage Determination, you can contact us via our secure messaging system at: PharmacyServices-Government@PacificSource.com.

Payment Requests

If you ask us for reimbursement or to pay a bill you have received from a provider for covered medical services or drugs, we are making a coverage decision for you whenever we decide what is covered for you and how much we pay. In some cases we might decide a service or drug is not covered or is no longer covered by Medicare for you. If you disagree with this coverage decision, you can make an appeal. Please see the section about appeals.

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Fax Us

For Medical Payment Requests:
541-322-6423

For Prescription Payment Requests:
541-382-4225

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For Medical Payment Requests:

For Prescription Payment Requests:

Office Locations

Complaints for Medical Care or Part D Prescription Drugs

A complaint is when you have a problem or concern with the quality of care, respect of your privacy, waiting times, information your get from us, customer service, timelines for coverage decisions and appeals, or other concerns. This type of complaint does not involve a coverage decision or a payment dispute. If your issue is with the plan’s coverage or payment, please see the section about Appeals.

Have a complaint? Please get in touch with Customer Service and we'll work to make it right.

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Fax Us

541-322-6424

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Appeals for Medical Care or Part D Prescription Drugs

If we make a coverage decision you disagree with, you can appeal our decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. When you make an appeal, we review the coverage decision to determine if rules were applied properly. Your appeal is handled by different reviewers than those who made the original unfavorable decision. When we have completed the review we give you our decision.

To start an appeal, contact us using the information below.

You can also file an appeal in InTouch, our secure member portal.

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Fax Us

541-322-6424

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Provider Contracting

For questions about provider contracting, please call us at one of the numbers below and ask for Provider Network.

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Agents

For fastest service, please contact our Medicare Broker Services team.

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