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 question the need for a doctor's form for my health monitor prescription. Using it for a year to test my health, I find the policy of form submission and doctor approval during a pandemic, which delays the process, to be unacceptable! With a prescription and a paid 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

In December , before the pandemic, we bought a two-week bus tour package and airfare to Spain and Portugal, set to start this week. We also got travel cancellation insurance from Pacific Blue Cross, preferring it over the travel agency's offer, believing PBC's was superior. We were promised a refund, not credits or vouchers, under our specific travel contract. Now, future travel isn't an option for us. Initially, refunds were available for cancellations from both the agency and airlines. We insured ourselves with this in mind. Post-pandemic, only credits or vouchers are offered, which wasn't what we insured against. The insurance company now denies our claim, arguing that a voucher equals a refund, which is utterly unacceptable.

My spouse and I made valid claims for orthotics purchases and submitted all required documents, but Pacific Blue Cross is challenging the acceptance of our claims. We each paid $399.00 on July 7th, and provided all necessary paperwork, including Proof of Manufacturing, signed diagnosis and prescription forms, and a prognosis letter from our assessing doctor. Despite numerous calls to PBC and providing all documentation, they claim it's insufficient. On August 10th, I emailed the documents due to website issues. After more calls and being told by a PBC rep that our documentation was complete, we're now told we need additional items like a credit card receipt and a doctor's referral letter. We've never faced such issues with claims before, and despite our polite demeanor, a PBC rep suggested we sounded hostile and offered no apology for the inconvenience. Our claim is under further review, and we're awaiting a promised callback from a manager.