Referring a Patient
Pacific Infusion strives to provide your patient with the best possible care.
Referring a patient for infusion therapy is an easy three step process:
Step 1: Select the medication from the list below and download the designated order form.
Step 2: Complete the order form.
Step 3: Fax the completed order form back to our office (310) 297.9222. Please include your patient’s details, including:
- Full contact information.
- Insurance information with a front and backside copy of the patient’s insurance card.
- Diagnosis with supporting documentation.
- Any additional information listed in the “Instructions” section of the medication page.
After receiving the order form and the patient’s information, we’ll work with you and your office to ensure that the insurance approval process is as quick as possible.
What Insurance Carriers Does Pacific Infusion Center Accept
Please check eligibility and authorization for all procedures and infusion services prior to office visits**** Thank You.
- ACCESS MEDICAL GROUP
- AETNA
- AFTRA HEALTH PLAN
- ALLIED HEALTH SOLUTIONS IPA
- ANTHEM BLUE CROSS
- ASSURANT HEALTH
- BLUE SHIELD OF CALIFORNIA
- BLUE ZONES HEALTH (FORMERLY ACCESS MEDICAL HEALTH)
- CIGNA
- DIRECTOR’S GUILD
- GEHA
- FIRST HEALTH
- HEALTHNET
- ILWU-PMA
- MHBP
- MOTION PICTURE HEALTH
- NALC
- MEDICARE
- PROVIDENCE ST JOHN’S MEDICAL GROUP
- STAR HEALTHCARE IPA
- UFCW UNION & FOOD
- UNITED HEALTHCARE
- NUMEROUS SELF-FUNDED PPOs
ALL OTHER HEALTH PLANS – We will submit your claim to your insurance as a courtesy. (This list is subject to change. Please call for the most up-to-date information.)
Select a Medication
We want to make the process for referring a patient for infusion therapy as simple as possible.
To achieve this, please choose a medication below for more information.
- Actemra (Tocilizumab)
- Benlysta (Belimumab)
- Boniva (Ibandronate)
- Cimzia (Certolizumab pegol)
- Cosentyx (Secukinumab)
- Crysvita (Burosumab-twza)
- Entyvio (Vedolizumab)
- Evenity (Romosozumab–aqqg)
- Ilumya (Tildrakizumab–asmn)
- Kisunla (Donanemab-azbt)
- Krystexxa (Pegloticase)
- Leqembi (Lecanemab-irmb)
- Leqvio (Inclisiran)
- Ocrevus (Ocrelizumab)
- Omvoh (Mirikizumab-mrkz)
- Orencia (Abatacept)
- Prolia (Denosumab)
- Remicade (Infliximab)
- Renflexis (Infliximab-abda)
- Rituxan (Rituximab)
- Saphnelo (Anifrolumab-fnia)
- Simponi Aria (Golimumab)
- Skyrizi (Risankizumab-rzaa)
- Solu-Medrol (Methylprednisolone)
- Stelara (Ustekinumab)
- Tepezza (Teprotumumab–trbw)
- Tremfya (Guselkumab)
- Uplizna (Inebilizumab-cdon)
- Zoledronic Acid (Generic)
More Information
Virtually all infusible or injectable medications require prior authorization for patients with commercial insurance coverage and Medicare Advantage. We ask that you review the information on the page below, for the appropriate drug, and send all the requested information with your orders so that our authorizations clerk may successfully and efficiently obtain the authorization on your patient’s behalf. We will promptly schedule patients only after the prescriber’s office has sent all the necessary documentation to obtain prior authorization.
For patients with Medicare, there are special considerations for referral. Prior to initiation of treatment, due to laws regarding Medicare compliance, one of our providers must perform an initial visit with your patient and annually thereafter to review the treatment plan of the treating physician. If you wish to refer a patient for off-label therapy, the treating physician must provide adequate written documentation of medical necessity and briefly discuss with one of our physicians. We will promptly schedule patients for off-label treatment regimens after this communication has occurred.
Our Medical Director and administering nurses welcome referring physicians and providers to contact us to discuss patients they have sent for administration of medications. We want to better understand any specific clinical aspects or needs of your patients. Our Medical Director is also available to answer any questions you may have regarding the therapies and protocols we utilize.
At the present time, we are not performing chemotherapy, blood, antibiotic infusion or IV hydration. Please check back often, as we will add medications as new indications or approvals come.
