Medicare - Bad customer Service, Not informed of the coverage they offer, and refusal to assist when necessary
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Update by user Nov 28, 2022
There seemly is "no end" to Pacific Source's inability to understand what they have taken on as an insurance program by attempting to do privatized Medicaid. I don't know if there will be a 'fix' or not to this problem.
They are taking on a federal program that has been branched off for their insurance purposes, but they fail to understand their responsibility to their clientele, especially understanding out of pocket costs, since dual eligible clients SHOULD NEVER pay out of packet as it is considered a federal offense. This needs to be addressed to the Federal Program, that is allowing them to privatized a federal program.
Original review posted by user Oct 29, 2022
Let me please open this with the fact I used to be a Dual Eligible Biller. This means I have a long history of working with insurances, that my expertise involved Medicare/Medicaid with successful turnaround for various medical companies federal laws involved with Medicare/Medicaid are very specific mandates.
Pacific Source does not seem to understand that when they decided to pick up "SNP" (dual eligibility for medicare/medicaid referring to "special needs" clientele) they HAVE to provide a link between state and federal support for their clients. This isn't my law, this is the federal mandates. They offer no alternatives when the state law says; "Patients are not allowed to pay out of pocket for services, medical supplies or medication." If PacificSource cannot find suppliers, medication coverages (often requiring Prior authorization), they recommend you pay out of pocket using "Good RX".
List Issues: "ghost doctor" referrals (list of doctors that are no longer providing under their insurance, retired, lost licenses for malpractice, deceased, some on the list were "never primary care physicians" (working as a specialized ER doctor), or in one case the doctor was not licensed to work in the USA.
Confusion of what they offer as insurance
Failure to know what "SNP" means or that they have a department for Dual Eligible coverage. They have split Medicaid in two, further confusing their customers in what services they actually have: one is part "C" with limited dental, eye care, behavioral services.
The secondary plan (meant to takeover Medicaid), does NOT have access to the state Medicaid system, so if there is a 'real problem' they cannot act as an advocate or intervene on the client's behalf.
Constant Rain of Paperwork that is useless.
They make automated calls at night and weekends when the office is closed. Being asked to take two "Wellness Visits".
They don't even know when the client has taken care of their visits. So you end up spending most of your time correcting letters they send, having to find your own doctors even if off list, and the never ending problems if you have dual eligibility.
User's recommendation: For all the corrections you will need to do to get your account handled properly, it is better to find another part C program, or return to standard Medicare.
Location: Eugene, Oregon
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