Reputation grade
A
Peer-relative, A–F
Insurer profile · NAIC + CMS
PacificSource Health Plans
PacificSource Health Plans's complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- A
- Reputation grade
- 3.5%
- Claims denied
- 2
- States (CMS data)
The verdict
PacificSource Health Plans earns a A reputation grade - far fewer consumer problems than peers of its size, according to CMS Transparency in Coverage filings, 3.5% of its marketplace claims were denied across 2 states.
- A
- reputation grade
- 3.5%
- claims denied (CMS)
Grades are peer-relative within PlainInsurer's dataset. A high complaint ratio is not proof of wrongdoing, larger insurers draw more complaints by volume, which the index normalises.
NAIC complaint index
N/A
1.0 = market average; lower is better
Claim denial rate
3.5%
CMS, 2 states
Reputation grade A (composite score 97.7) - A=Excellent, F=Failing. Based on NAIC complaint ratios and CMS denial data.
Among states with enough reported claims to compare, PacificSource Health Plans's highest marketplace denial rates in this dataset are in Montana (5.9%) and Oregon (2.6%). State-level rates reflect the specific plans PacificSource Health Plans offers there and how each state's regulators and utilization-review rules apply, not necessarily the carrier's national practice.
CMS marketplace filing
Reported appeal outcomes for PacificSource Health Plans
5,032
appeals filed
1,172
overturned (reported outcomes)
23.3%
of appeals with a reported outcome
The largest state samples are Oregon (4,055 filed, 946 overturned) and Montana (977 filed, 226 overturned); 2 states contribute to the profile total.
CMS reports an overturn outcome for 5,032 of these 5,032 filed appeals; missing outcomes are excluded from the percentage. These filing totals are not a prediction for an individual appeal. View the CMS source ↗
What the data shows for PacificSource Health Plans
PacificSource Health Plans carries a A reputation grade in PlainInsurer's dataset, with a composite score of 97.7 (higher means more consumer friction relative to size). It does not yet carry enough NAIC complaint history for a normalized complaint index.
On the claims side, CMS Transparency-in-Coverage filings show PacificSource Health Plans denied 3.5% of marketplace claims across 2 reporting states - a moderate rate that still varies by plan design and network.
In short: complaint and denial data show how PacificSource Health Plans compares to peers, not what your own claim experience will be. Weigh price, coverage terms and state licensing before any purchase. Source: NAIC Consumer Information Source complaint data (2024). Source: CMS Transparency in Coverage PUF (PY2025), cms.gov.
Use this data wisely. Complaint and denial figures reflect regulatory filings, not individual claim outcomes. A high complaint ratio is not proof of illegal behaviour. This page is informational and is not financial, legal, or insurance advice, verify coverage decisions with your insurer or a licensed agent.
Other A-graded carriers in PlainInsurer's dataset include Lincoln National Life and Principal Financial, and the closest overall composite score to PacificSource Health Plans's 97.7 belongs to Avera Health Plans, Inc. (98.3).
Other A-graded insurers
Carriers with the same peer-relative reputation grade
| Insurer | Grade |
|---|---|
| Lincoln National Life | A |
| Principal Financial | A |
| TIAA Life | A |
| Mutual of Omaha | A |
| USAA Homeowners | A |
Closest composite score to PacificSource Health Plans
Carriers with the nearest overall composite score (97.7)
| Insurer | Composite score |
|---|---|
| Avera Health Plans, Inc. | 98.3 |
| Sanford Health Plan | 96.6 |
| Imperial Insurance Companies, Inc. | 98.9 |
| HealthPartners Insurance Company | 95.5 |
| Kaiser Foundation Health Plan, Inc. | 94.9 |
What to do with this
How to act on PacificSource Health Plans's complaint and denial record.
- Compare this carrier side-by-side with another before you buy. Compare insurers
- See how every insurer in your state ranks on complaints and denials. Browse by state
- Denied a claim? Learn the internal and external appeal process. Appeal a denial
Complaint ratios normalise by premium volume so larger carriers are not penalised for writing more policies.
Frequently asked questions
What does PacificSource Health Plans's grade mean?
PacificSource Health Plans received a grade of A, indicating far fewer consumer problems than peers of its size. PlainInsurer grades insurers on a curve relative to the ~200 carriers in our dataset, using the NAIC complaint index (normalized by premium volume), CMS claim denial rates, and Medicare Advantage prior-authorization data where available.
How many complaints does PacificSource Health Plans have?
NAIC's public bulk data does not include a complaint-volume estimate for PacificSource Health Plans - the carrier may be new, small, or file under a parent company. Absence of an estimate is missing data, not evidence of zero complaints.
How do I file a complaint against PacificSource Health Plans?
Contact your state's Department of Insurance, most accept complaints online, by phone, or by mail. The NAIC also runs a central portal at naic.org. Document your policy number, claim number, dates, and the issue before filing.
Is PacificSource Health Plans a good insurance company?
It depends on your coverage needs, state, and budget. PlainInsurer's A grade reflects far fewer consumer problems than peers of its size relative to peers. Always compare quotes from multiple carriers and check complaint data for your specific state and line of coverage.
What types of insurance does PacificSource Health Plans offer?
Detailed line-of-business data isn't currently available for PacificSource Health Plans. The carrier is licensed in 0 states.
Source: NAIC published complaint index + CMS Transparency in Coverage PY2025 Complaint index, reputation grade and per-state claim denial rates for PacificSource Health Plans · 2024 NAIC complaint index aggregates state-DOI consumer complaints, normalized against premium volume (1.0 = market average). Denial rates from CMS Transparency in Coverage PY2025. Reputation grade is PlainInsurer's peer-relative methodology applied to this public data.
Download the data behind this page
The full PlainInsurer extract, covering every insurer including PacificSource Health Plans, is available as CSV and JSON. Underlying federal data is public domain; see our methodology for the compilation and grading method.
Data: NAIC published complaint index (2024) · CMS Transparency in Coverage PUF PY2025. Not affiliated with NAIC or CMS.
Every figure on PlainInsurer comes directly from NAIC MCAS and CMS Transparency in Coverage data; no editor types in numbers. See our editorial standards or methodology, or report an error. Data current as of 2026-07-28. Grades measure only the published complaint/denial data; we don't recommend any insurer or policy.