Insurance Accepted

Pacific Medical Centers is committed to making it simple for our valued patients to receive the care they need by offering a full range of primary and specialty services and accepting most major insurance plans.

We accept the following health insurance plans. If you are calling for a Behavioral Health appointment, please check with your insurance carrier for benefits and a listing of their participating network providers. Always check your coverage with your insurance carrier if you have questions.

It is always a good idea to call your insurance carrier about specific care you might seek or be referred to. That way you can learn in advance what your out-of-pocket costs might be. Read more tips on getting the most out of your insurance.

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2021 Medicare Options Accepted

  • Traditional Medicare (Part B)*
  • Medicare Prescription Drug coverage (Part D) – at Maxor pharmacies located in PacMed clinics
  • Medicare Advantage (Part C) – PacMed accepts a variety of these plans. Please see each insurer below for their specific Medicare Advantage plans where we are in network.
  • Medicare Supplemental (“Medigap”) plans can also be used to pay for care at PacMed; these plans pay secondary to Medicare and may cover an additional percentage of Medicare Part B-eligible services. PacMed accepts all Medigap plans for those who also have Medicare as primary insurance.

* Note: Medicare Part A coverage is hospital insurance; PacMed does not have a hospital so this coverage does not apply. Please check with our affiliated hospital in your area about their Medicare Part A policy in case of hospital admissions.

2021 Group, Exchange and Other Plans Accepted

Start by looking for your insurance carrier’s name, then search for your plan under the category it falls within:

*Medicare Advantage Plans may vary by clinic. You can contact Connexion Insurance Solutions at 1.877.315.3279 to find a plan that meets your needs. The plans listed below are not a complete listing of Medicare plans available in your service area. For a complete listing, please contact 1.800.MEDICARE (TTY users should call 1.877.486.2048), 24 hours a day/7 days a week or consult www.medicare.gov.

 

Click the “+” next to an insurer to view their plans we accept:

Group / Employer Plans
All commercial plans including Aetna Whole Health

Medicare Advantage Plans
Aetna Medicare Choice Plan (PPO)
Aetna Medicare Eagle Plan (PPO)
Aetna Medicare Elite Plan (HMO)
Aetna Medicare Platinum Plus Plan (HMO)
Aetna Medicare Prime Plan (HMO)
Aetna Medicare Select Plan (PPO)
Aetna Medicare Value Plan (HMO)
Aetna Medicare Value Plus Plan (HMO)

 

Out of Network: N/A
Not Accepted: Exchange and Individual Plans
Not Applicable: Medicaid Plans

NOTES

Also see “Coventry/First Health” below.

Group / Employer Plans
Cigna/Cigna FlexCare/Great West- all commercial plans

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans

Medicare Advantage Plans
CHPW Medicare Advantage  (A, B)

Medicaid Plans
Apple Health CHPW  (A, B)

 

Out of Network: N/A
Not Accepted: CHPW Exchange Plans; see notes
Not Applicable: Group/Employer Plans

NOTES

A  Specialty Care only; Primary Care not accepted with this plan
B  Specialty referrals limited to Providence & Swedish as referring provider

 

Exchange and Individual Plans  (D)
Ambetter Exchange:
Ambetter Essential Care
Ambetter Balanced Care
Ambetter Secure Care
Ambetter Cascade 

 

Medicaid Plans  (D)

Apple Health Coordinated Care ‘Core Connections” Foster Care

Apple Health Coordinated Care – Non-Foster   (A, B)

 

Out of Network:  N/A
Not Accepted:  Apple Health (non foster) for primary care; or for specialty referalls from outside the Providence/Swedish network
Not Applicable:  Group/Employer Plans; Medicare Advantage

NOTES

A  Specialty Care only; Primary Care not accepted with this plan
B  Specialty referrals limited to Providence & Swedish as referring provider
E  Routine vision care covered by Envolve does not cover PacMed; please seek out a contracted provider.

 

Coventry/First Health

Aetna Network

PacMed accepts all Coventry/First Health plans utilizing the Aetna network.

 

Out of Network:  N/A
Not Accepted:  N/A
Not Applicable:  N/A

Group / Employer Plans
EverMed Direct Primary Care

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans

Group / Employer Plans
First Choice Health Network

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans

Group / Employer Plans
HMO and PPO Plans

Medicare Advantage Plans

Humana Honor (PPO)

HumanaChoice:
HumanaChoice H5216-047 (PPO)
HumanaChoice H5216-048 (PPO)
HumanaChoice H5216-247 (PPO)

Humana Value Plus H5619-134 (HMO)

Humana Gold Plus:
Humana Gold Plus H2486-006 (HMO)
Humana Gold Plus H2486-007 (HMO)
Humana Gold Plus H5619-056 (HMO)
Humana Gold Plus, H5619-057 (HMO)
Humana Gold Plus H5619-059 (HMO)
Humana Gold Plus H5619-060 (HMO)
Humana Gold Plus H5619-061 (HMO)
Humana Gold Plus H5619-062 (HMO)
Humana Gold Plus H5619-063 (HMO)
Humana Gold Plus H5619-064 (HMO)
Humana Gold Plus H5619-097 (HMO)
Humana Gold Plus H5619-099 (HMO)
Humana Gold Plus H5619-100 (HMO)
Humana Gold Plus H5619-101 (HMO)
Humana Gold Plus H5619-114 (HMO)
Humana Gold Plus H5619-115 (HMO)
Humana Gold Plus H5619-129 (HMO)
Humana Gold Plus H5619-133 (HMO)

Dual-eligible Medicare/Medicaid members:
Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)

 

Out of Network: Any plans not listed
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans

Medicare Advantage Plans
Accepting all ICHS – PACE Medicare Advantage plans  (A, B)

 

Out of Network:  See notes
Not Accepted:   See notes
Not Applicable:  Group, Exchange, Commercial plans.

NOTES

A  Specialty Care only; Primary Care not accepted with this plan
B  Specialty referrals limited to Providence & Swedish as referring provider

 

Group / Employer Plans
Options PPO
Access PPO

 

Medicare Advantage Plans  (C, E, F)
Kaiser Permanente Medicare Advantage Anchor (HMO)
Kaiser Permanente Medicare Advantage Basic (HMO)
Kaiser Permanente Medicare Advantage Centennial (HMO)
Kaiser Permanente Medicare Advantage Columbia (HMO)
Kaiser Permanente Medicare Advantage Essential (HMO)
Kaiser Permanente Medicare Advantage Harbor (HMO)
Kaiser Permanente Medicare Advantage Key (HMO)
Kaiser Permanente Medicare Advantage Optimal (HMO)
Kaiser Permanente Medicare Advantage Vital (HMO) Humana Honor

 

Exchange and Individual Plans  (C, F)
Kaiser Permanente Cascade Gold
Kaiser Permanente Cascade Silver
Kaiser Permanente Cascade Bronze
Flex Gold – 21
Flex Silver – 21
Virtual Plus Silver – 21
Bronze – 21
Flex Bronze – 21 Bronze HSA – 21
Virtual Plus Bronze- 21
Basic Plus Catastrophic Plan – 21

 

Out of Network: See notes.

Not Accepted: See notes.

Not Applicable: Medicaid Plans

NOTES

C  Prior Authorization is required. 
E Kaiser Medicare Advantage (MA) and Exchange/individual plans are contracted, but we are not preferred/designated as in-network. However, some specialists may be designated as in-network; please inquire with Kaiser before receiving care.
F  On these plans, you cannot see a PacMed Primary Care provider.

 

Group / Employer Plans
Lifewise Health Plan of WA Preferred
LifeWise Assurance Co.
LifeWise Primary
LifeWise Alpine

Exchange and Individual Plans
LifeWise Cascade Select Gold
LifeWise Cascade Select Silver
LifeWise Cascade Select Bronze
LifeWise Cascade Gold
LifeWise Cascade Silver
LifeWise Cascade Bronze
LifeWise Essential Gold
LifeWise Essential Silver High Deductible
LifeWise Essential Silver Low Deductible
LifeWise Essential Bronze
LifeWise Essential Bronze HSA
LifeWise Essential Bronze II

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Medicaid Plans

Exchange and Individual Plans
Molina Cascade Gold
Molina Cascade Silver
Molina Cascade Bronze
Molina Choice Gold
Molina Choice Silver
Constant Care Silver 1
Core Care Bronze 1

 

Medicare Advantage Plans
Accepting all Molina Medicare Advantage plans  (A, B)

 

Medicaid Plans
Accepting all Molina Managed Care Apple Health/Medicaid plans  (B, E)

 

Out of Network: Molina Medicare
Not Accepted: N/A
Not Applicable: Group / Employer Plans

NOTES

A  Specialty Care only; Primary Care not accepted with this plan.
B  Specialty referrals limited to Providence & Swedish as referring provider.
E  The doctors at our Puyallup clinic are currently unable to see new Medicaid patients. This includes Molina Medicaid plans. Please contact your insurance provider for a list of local doctors you can see, or visit the Provider Search page for Molina.

If you have Molina or other Medicaid eligibility-related questions, please call 206.621.4049.

Group / Employer Plans
All PPO products

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans

Group / Employer Plans
Premera Blue Cross Foundation
Premera Blue Cross Foundation Plus 1
Premera Blue Cross Global
Premera Blue Cross Heritage
Premera Blue Cross Heritage Signature
Premera Blue Cross Individual Signature

Medicare Advantage Plans
Premera Blue Cross Medicare Advantage (HMO)
Premera Blue Cross Medicare Advantage Classic (HMO)
Premera Blue Cross Medicare Advantage Core (HMO)
Premera Blue Cross Medicare Advantage Core Plus (HMO)
Premera Blue Cross Medicare Advantage Classic Plus (HMO)
Premera Blue Cross Medicare Advantage Charter + Rx (HMO)
Premera Blue Cross Medicare Advantage Alpine (HMO)
Premera Blue Cross Medicare Advantage Sound + Rx (HMO)
Premera Blue Cross Medicare Advantage Peak + Rx (HMO)
Premera Blue Cross Medicare Advantage Total Health (HMO)

Exchange and Individual Plans
Premera Blue Cross Cascade Gold
Premera Blue Cross Cascade Silver
Premera Blue Cross Cascade Bronze
Premera Blue Cross Preferred Gold EPO
Premera Blue Cross Preferred Silver EPO
Premera Blue Cross Preferred Bronze EPO
Premera Blue Cross Preferred Bronze HSA EPO 6100

 

Out of Network: Premera Blue Cross Heritage Prime, Premera Blue Cross Heritage Prime HPN, Premera Blue Cross Peak Care (Multicare EPO/Tahoma Network)
Not Accepted: N/A
Not Applicable: Medicaid Plans

Group / Employer Plans
Providence Health Plan

Medicare Advantage Plans
Providence Medicare Focus Medical (HMO)
Providence Medicare Select Medical (HMO-POS)
Providence Medicare Timber + RX (HMO)
Providence Medicare Extra + RX (HMO)
Providence Medicare Choice + RX (HMO-POS)
Providence Medicare Bridge 2 + RX (HMO-POS)
Providence Medicare Summit + RX (HMO-POS)
Providence Medicare Harbor + RX (HMO)
Providence Medicare Cottonwood + RX (HMO-POS)
Providence Medicare Pine + RX (HMO)

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans, Medicaid Plans

Group / Employer Plans
Regence Blue Shield
Regence Uniform Medical Plan
Regence Select Network
Regence Selections

Medicare Advantage Plans
Regence Valiance (PPO)
Regence MedAdvantage + Rx Classic (PPO)
Regence MedAdvantage + Rx Primary (PPO)
Regence MedAdvantage + Rx Enhanced (PPO)
Regence BlueAdvantage HMO Plus (HMO)
Regence Valiance (HMO)
Regence BlueAdvantage HMO (HMO)
Regence Align (HMO)
Regence Align Plus (HMO)

 

Out of Network: Regence KingCare Select
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans, Medicaid Plans

Group / Employer Plans
USFHP (Uniformed Services Family Health Plan) – All Plans

 

Out of Network: TRICARE Prime, TRICARE Select
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans

Group / Employer Plans
United Healthcare Core
United Healthcare Choice Plus
United Healthcare Navigate

 

Medicare Advantage Plans
AARP Medicare Advantage (HMO)
AARP Medicare Advantage Choice (PPO)
AARP Medicare Advantage Patriot (HMO-POS)
AARP Medicare Advantage Plan 1 (HMO)
AARP Medicare Advantage Plan 1 (HMO-POS)
AARP Medicare Advantage Plan 2 (HMO)
AARP Medicare Advantage Plan 2 (HMO-POS)
AARP Medicare Advantage Plan 3 (HMO)
AARP Medicare Advantage Walgreens (HMO)
AARP Medicare Advantage Walgreens (HMO-POS)

 

Medicaid Plans
United Healthcare Apple Health (Medicaid)  (A, B, D)

 

Dual-eligible Medicare/Medicaid members:
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
UnitedHealthcare Dual Complete (HMO D-SNP)

 

 

Out of Network: N/A
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans

NOTES

A  Specialty Care only; Primary Care not accepted with this plan.
B  Specialty referrals limited to Providence & Swedish as referring provider.
D  Prior authorization is required for all routine eye exams. Authorizations must be obtained from MARCH Vision Care. PacMed is not contracted with MARCH. 

 

Medicare Advantage Plans  (D)
WellCare Value ( HMO)
WellCare Premier (PPO)
WellCare Patriot (PPO)
WellCare Dividend (HMO)
WellCare Access (HMO – DNSP)
WellCare Liberty (HMO – DNSP)
WellCare Prime (PPO) 

 

Out of Network:  N/A
Not Accepted:  N/A
Not Applicable:  Exchange, Commercial, and Medicare plans

NOTES

D PacMed is not contracted with Premier Eye Care. Please look for a contracted provider for routine vision services.

Vision Care Coverage

  • PacMed does not accept separate vision insurance products (such as VSP, Davis Vision, EyeMed, Humana Vision, etc.) for routine/preventative eye care from any outside insurance provider. Vision care with PacMed is only typically covered if it is included in your medical plan’s “Summary of Benefits,” and/or associated with a medical issue (such as diabetes eye care). Even if a medical condition is present, some of your exam may not be covered if you have a separate vision plan.Before seeking vision treatment, we highly recommend that you CALL YOUR INSURANCE CARRIER and ask whether the services you are seeking are covered at PacMed. (If they confirm, ask for a call reference number for your records.)

Getting the Most Out of Your Health Insurance

We’ve put together some helpful tips to save you time and help you get the most out of your medical insurance. To maximize your health insurance benefits, please contact your insurance company’s Customer Service department for policy and benefit verification. The Customer Service phone number should be located on the back of your health insurance ID card.

  • Please check with your insurance carrier for information on required referrals, authorizations and co-payments.
  • Ask your insurance company about any upcoming procedures or visits to confirm coverage (see below)
  • Please bring your insurance card to every appointment.

As with everything, good communication is the key to working well with insurance companies. Because policies vary, it’s important to contact your insurance company directly to confirm how your plan will pay charges for services and to keep records of the conversations.

1) Prior to your visit, ask your provider or care team:

  • Is this a routine exam (i.e. an annual exam or physical)?
    • Please note, if your visit is a routine annual exam or physical, your doctor will not be able to address questions about specific symptoms or health concerns, per insurance company contracts and rules. If you discuss medical issues outside the scope of a routine annual exam or physical, we are required to include that in our notes which will result in the visit being upgraded to a regular office exam, and may no longer be covered 100% by your insurance.
  • What procedure (CPT) codes will likely apply to my visit/course of treatment?

2) Then, call your insurance company with your questions about their coverage of your upcoming visit. Some things you might ask:

  • Do I have benefit coverage for (service name/CPT code)?
  • Is a referral or preauthorization necessary to have this service? (If yes, your primary care provider must initiate the referral or preauthorization.)
  • Do I have a deductible?
  • Following my deductible, how much will I owe?
  • How much will I be responsible for paying following the insurance coverage?
  • What is the call reference number for this conversation? (use this in case you need to refer back to the call later if there are any disputes).

Do you need health insurance coverage?
If you need help finding insurance coverage for yourself or loved ones, please visit Washington Healthplanfinder.

Questions? Please call 206.621.4049.

Are you an external provider group of facility looking to refer your patient to PacMed?
Please fax in your request and all applicable chart notes to our centralized referral team at 206.505.1445.

Questions about the Affordable Healthcare Act? You can find more information here.

If you are unable to pay your full statement balance, please contact the Pacific Medical Centers Patient Accounts department at 206.621.4392 to discuss payment options.