10 Most Common Questions at Benefit Meetings
We have a team of insanely knowledgeable service reps who’s mission is to visit the companies who’ve purchase a PacificSource plan and explain the benefits to the employees, as well as answer all sorts of questions on how they can use their benefits. In their quest to make sure our members feel comfortable with their benefits, they wanted to share their ten most commonly asked questions.
How do I find a doctor that is in-network? How do I do this for when I travel?
When searching for an in network provider in our service area, you can search via our website at www.pacificsource.com/find-a-provider/ be sure to select the network that coincides with your plan. You can also search for providers outside of our service area by going to this same link and selecting the state in which you are traveling. This will direct you to the First Health or First Choice provider directories depending on the state.
My daughter lives in Texas (or any other state), how are claims paid for her?
If First Health or First Choice is not an option for the state in which you are traveling then the claim will process at the out of network benefits.
Do you have a separate network for alternative care doctors and, if so, what is it?
No, the network is the same for all of your providers in the service area.
Do I have to satisfy a new deductible at renewal? (for groups that renew in a month other than January)
Depending on whether your plan runs on a calendar or plan year, your deductible, out of pocket and any visit limitation would start over again on that date.
For new groups: If I have already satisfied my deductible with my prior insurance will I have to satisfy a new deductible?
If the group is coming to PacificSource in the middle of the plan year then we will give deductible credit. If the group is starting new with PacificSource as of January 1 then the member would need to satisfy the new deductible even if they met their deductible on their prior insurance.
How long does it take to get our ID card?
You should receive your ID card before the effective date of your insurance plan. If this has not been received you can also print a temporary ID card on our website. You can do this at https://intouch.pacificsource.com/Members/IdCard/Temporary you will need to enter your name, date of birth and PacificSource member ID or social security number.
Are virtual Skype doctor visits covered?
Telemedicine would be covered as long as it is a covered service and the provider offers two way real time video that is HIPAA compliant. If the type of service is something that would require a prior authorization in person, then it would also still require a prior authorization via Skype.
After hearing that a benefit is not covered, they ask “well, would it be covered if I had a doctor’s note”?
Unfortunately it would still not be covered even with a doctor’s note. This would be an exclusion on the plan.
Do I need to have a referral to see a specialist?
If you are on a Prime plan then a referral would be required to see a specialist. All other plans do not require a referral to see a specialist.
Do my prescription copays and vision copays go towards my out-of-pocket?
This is really going to depend on the plan. For most plans, prescription and vision copays apply to the out of pocket. (See plan for details)
The plan may have prescription and vision applying to deductible however, we would need to check the plan details.
Do you have a question about managing group health plans? Please ask us in the comments below.
Continue learning with us!
Receive our blog in your email inbox.