Pacific Blue Cross
Reviews and Complaints

During the Covid crisis there has been little assistance or flexibility offered to customers from the Pacific Blue Cross despite a drastic reduction in claim filings because of closed Chiro, Dental, Optometry, Massage Therapy etc. Full premiums charged during this time does not show well on this provider.

I recently made an error on my online claims. They suspended me account be neglected to inform me about it or what I should do to rectify the situation. I found out a good deal later and had to call customer service to find out what was wrong and what to do. After finally figuring out that I needed to redo the entire claim via mail I set about getting the receipts from the companies and filling out the forms. I double check that I had everything filled out properly with customer service and sent it in. I've done that twice now, as both times PBC has lost the letter. The customer service department has been friendly and as helpful as they can be, but due to complete bureaucratic incompetence they are not able to do anything for me. They cannot accept emails of the receipts (which can't get lost) and they cannot allow me to drop the claim. So, until they finally are able to receive my third attempt (which I will have to hand deliver) I have a myriad of claims sitting unprocessed because I do not trust their ability to handle paper claims. I have been dealing with this for the past six months now and they simply will not communicate, offer any apologies, or suggest alternatives to their inept system of handling physical paper. I like being able to claim things online simply because I do not have to deal with their inadequacy.

I've repeatedly questioned PBC why they don't allow chronic patients to submit CGM claims digitally, but I've yet to receive a clear answer aside from "we just don't". They require users to print a form from their website, print the invoice emailed to us by the service provider, and send both in an envelope by post. It's a waste of time and paper, and in the current climate, a completely unnecessary risk for chronic patients for whom going to the post office poses an infection risk for COVID-19. It makes no sense, particularly when digital submissions are accepted for most claims. Why require paper verification? They never give clear responses for this, and there is a complete lack of transparency. It's 100% illogical to pretend paper submissions are more secure when we're printing off digital invoices. So is it an underhanded delay tactic, or is PBC behind the times? When pushed for answers by various users on public channels, PBC pushes for phone calls. Never in writing. Why can they only handle the explanations behind closed doors? Surely it should be public knowledge? Why won't they provide this in writing? It's not a privacy issue and contains no information about particular patients, because - for example - they have a blanket requirement for all diabetics submitting CGM claims. It's possible to give general info about what kinds of claims are required on paper and why, as this is a policy issue (not a privacy one) and that info isn't subject to the same protections. We deserve answers why digital invoices are required to be submitted on paper. What is the legal precedent? Are your systems outdated? This should be public record. The fact that something 100% illogical (like an inconsistency in which claims are required digitally vs on paper) is never addressed in writing suggests to me that something unethical is happening. *** Are you simply ill equipped from a technological perspective - meaning your business is subpar - or are you actually doing something unethical for financial gain? I can't see any other logical reason for you enforcing an utterly illogical policy for claim submissions.

I purchase health insurance from Pacific Blue Cross, but they routinely deny legitimate claims. The onus is on me to notice that. If too much time passes they say my benefits are null and void.

I do NOT see why i would need to have a form filled out from my doctor prescribing my *** monitor. I have been using this for over a year now to test my ***. *** They policy of having to fill out a form, than having it to be sent off to my doctor during a pandemic (meaning it now may take months) is unacceptable! If I have a prescription for it and I am paying for my plan - There should be no issue.

I had been using my physio benefits that were partially rendered by a kinesiologist under the supervision of a physio. My account was flagged for some reason after months with no concerns; I was not notified properly that it wasnt covered and they ended up blocking my account. I cannot submit my benefits now. My physio clinic and I have called PBC multiple times and they often do not understand, agree and then disagree, etc. This has been going on since January . I ended up owing money and not being able to further submit my other benefits such as counselling. I called them about a month ago and they said they would send me a letter to sign and acknowledge that kinesiology isnt covered, they never sent it. Now theyre saying they have no record of this and Ive been waiting for months. Now they want me to send a letter with no clear direction or else theyll block my coverage. This is employer paid benefits which they are denying.

purchased dental-only plan on Pacific Blue cross website using 'buy now' feature . At no point during this customer journey was welcome period mentioned. few weeks later called Pacific Blue Cross and asked when I'd be covered, they said May1 welcome package containing: Individual plan agreement with following information: effective date: May 1 Welcome Letter contains following information: your plan is effective May 1. 'we have enclosed your identification cards and agreement. it is imperative that you review your agreement' *From all the above (phone call, sign up process, welcome package) I have no way of knowing there is a 3 month waiting period. *Pacific Blue Cross in retrospect agreed there was no mention of welcome period during online sign-up / purchase process and refused to find recording of phone call, but said welcome period was mentioned on page 26 of a brochure they mailed. I did not receive a brochure, and the welcome letter didn't say to look for 1

December , prior to the pandemic, We purchased a two week bus tour package from *** and airfare from *** to Spain and Portugal which was to commence this week. At that time, we also purchased travel cancellation insurance from Pacific Blue Cross as we opted to forgo the travel agencies insurance offer since we believed that the insurance offered by PBC was far superior. We were assured that this insurance would provide us with a refund and not credits or vouchers for future use. We entered into a specific contract for services and specific time of travel. Future travel is out of the question for us at this time. At the time of purchase both the travel agency and airlines were still offering REFUNDS for cancelled trips. We purchased insurance knowing this was what was available at that time. Now, after the pandemic was announced both the airline and travel agency will only offer credits or vouchers. We did not purchase insurance to receive a credit or voucher. Now the insurance company refuses to honour our claim because they say that since the travel agency is offering a voucher/credit that it is considered a refund. *** Totally unacceptable.

Although my spouse and I made legitimate claims for purchases of orthotics at *** and submitted all of the appropriate documents, Pacific Blue Cross is putting up a roadblock to accept the claims of my spouse, Lana Burt, and myself. We had each paid $399.00 on our credit cards on July 7th for the purchase of orthotics and have supplied all of the necessary paperwork. Specifically, we each have sent a Proof of Manufacturing form, a signed diagnosis and prescription form from ***, and a signed diagnosis and prognosis letter from Dr. *** who did a full assessment on both of us. I have spent countless hours on the phone with representatives from PBC and as of today they still are stating that they don't have enough documentation. On August 10th I spent two hours on the phone with PBC rep Alayah as the PBC website was not uploading the documents properly, and so I had to send them as attachments to an email Alayah gave me (reference #: ***). Yesterday my spouse and I spent two and a half hours on the phone with PBC, first with a PBC rep named Pizziana and then with Mike from Burnaby. We were informed by *** that we sent was all the documentation that we needed. *** I have sent a detailed complaint email to the customet complaints dept. with PBC on Aug. 11th (with all reference numbers fro all of my interactions with PBC) and to date have not received a reply from them. Today my spouse called PBC and the rep she talked to said we still need to send a credit card receipt (in addition to the printed receipt we already sent) and a referral letter from a doctor. I have contacted *** and they are now sending this credit card receipt by email to my spouse and then we will forward it to PBC. I have also had orthotics over the years and have never had this kind of problem with a ckaim. I was diagnosed with *** many years ago, and recently continue to be diagnosed with this by Dr. ***. My spuse is currently dagnosed with ***. Today, the PBC rep, named Janet, stated that she thought we sounded hostile on the phone and did not apologize for any of the many inconveniences we have experienced with PBC (we were polite in our conversation wuth her). She was adament that we did not submit enough documentation and said our claim had been moved along for further review. When we asked if a supervisor ot manager was availabe so said there were none available at this time. She said that she will alert a manager to call us within the next 48 hours (no manager has called us back). The reference number for this call is: ***. It is apparent from this that there is no sincere effort by PBC to follow through with processing our claim.