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 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 below about appeals.

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For Medical Coverage Decisions:
541-382-2952

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

Note to Providers: Effective November 1, 2014, we are requesting that medication authorizations be submitted online via the InTouch portal (link above). This transition is being implemented to allow faster turnaround on medication authorization requests.

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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 below 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:

Our Office Location

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 problem is about the plan’s coverage or payment, you should look at the section above about making an appeal.

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541-322-6424

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Appeals for Medical Care or Part D Prescription Drugs

If we make a coverage decision and you are not satisfied with this decision, you can “appeal” the 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 we have made to check to see if we were following all of the rules 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.

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541-322-6424

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Provider Contracting Questions

For questions about Provider Contracting, please call one of the phone numbers listed 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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