Complaints

This profile includes complaints for Pacific Blue Cross's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Pacific Blue Cross

  PO Box 7000 Vancouver, BC V6B 4E1

  
• 

  Pacific Blue Cross

  4250 Canada Way Burnaby, BC V5G 4W6

  

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:06/12/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My daughter was diagnosed with jaundice at 2 days old, and required care. In home registered nursing is covered under my medical insurance plan from pacific Blue Cross as long as a doctors note is provided and it is an acute illness. I called blue cross and confirmed an acute illness is considered under 3 months - again, my baby was 2 days ****** doctor provided the note stating an in home RN was required for my daughter's acute illness - exactly what their policy needed, however my claims have ongoing been rejected claiming, where they now claim her illness is considered chronic - not acute despite my doctor confirming it is acute in the note and the fact that she was 2 days old when this was diagnosed. How is a 2 day old baby who hasn't even been alive long enough to have a chronic illness when the definition of chronic is over a long period of time?They have done everything to reject the claim, even though they had confirmed her illness was acute previously.

  

  Business Response

  Date: 17/12/2024

  Dear Member,
  We regret to inform you that the claim was not approved as it did not meet the required criteria. 
  Regards,

  Customer Answer

  Date: 17/12/2024

   
  Complaint: 22647651
  
  I am rejecting this response because: my claim DOES meet the required criteria, as I have confirmed with customer service multiple times that the criteria includes 1. ** note and 2. Acute medical illness. Given both these were provided and detailed in the ** note, what other criteria am I missing that would cause the claim to be rejected? My policy includes in-home Nursing.

  
  ****** ******

  

  Business Response

  Date: 20/12/2024

  Dear member, we are sorry to hear that your experience with Pacific Blue Cross was less than satisfactory in this instance.  We have investigated the matter and unfortunately the claim you have referred does not meet criteria under your plan.  ******************** Representatives are pleased to go over any questions you may have about your covered benefits or benefits you may want to opt in to in the future.

• Initial Complaint

  Date:27/11/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I made a recent previous complaint as Blue Cross did not process my claims for a compounded medication for most of 2024. Only after I made a Better Business Bureau Complaint was the claim resolved. However following resolution on my next submission to them for the same medication- which I completed a month ago was again given "pended" status following further review with no reimbursement. They do not seem to have permanently resolved the issue and it is not clear why this medication coverage they approved after the complaint has been pended and delayed payment again. This issue and the response continues to be a challenge and again is unresolved.

  

  Business Response

  Date: 10/12/2024

  We at Pacific Blue Cross sincerely apologize for the delay in processing your recent claims. Due to their nature, these claims required additional review, which has now been completed.  We're pleased to inform you that all previously pended claims have been processed.
  At Pacific Blue Cross, we are committed to providing exceptional service and a quality experience to all our members. We appreciate your patience and understanding during this process. Your feedback is invaluable as we continuously strive to improve our services.

• Initial Complaint

  Date:26/11/2024

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been trying to get reimbursed from this insurance company for six months. Since July.They owe me just over, 300 dollars.Every single time I contact them, they tell me it's going to be another ten days, then another 7 days, then another 10 days, this goes on and on. Each time they ask for 4-8 prices of information to verify it's me.Clearly they have no intention of paying what they legally owe, I'm obviously not going to take them to small claims court for 300 dollars. I spoke with my employer, they are looking into it but already said there isn't likely much they can do other than they will likely find another insured when renewal comes up. Depending on how many employees are getting robbed by this company.Not sure where else to seek help, though I have been advised to consult with my local MP and perhaps news media outlets to he the word out on the deep level of corruption within this company.Please advise.

  

  Business Response

  Date: 05/12/2024

  Dear Member, your complaint is currently under review by the ************************** Thank you for your patience
  

• Initial Complaint

  Date:21/10/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  June 11, my wife was fitted for orhotics.We had multiple prescriptions, and other ************'s now friggin October and they just denied the claim because we didn't submit which type of fit they used. They didn't friggin just ask for the stupid new document, they denied the claim, so now I have to go through the whole **** process again.The processing time is just absolute horse ****.Also, their stupid claim form, reset itself on me six times. I didn't click anything incorrectly, it just crashed. Not my browser, just their stupid webform.Examples: Once when I uploaded the documents, once right before I clicked the submit ********* seems they make their website unstable, and difficult to use as possible to minimize the claims they have to pay out.Further, they add so many documentation requirements for simple things like orthotics, they are basically begging you to forget or miss one because their form upload is buggy and it doesn't always work.Also they lie on the claim details form and it says the Received Date for the claim was Oct 18th, however that's the friggin date they sent me the reject message.Whomever designed their claim form and process should be fired. It shouldn't be this buggy and it shouldn't take two months to process claims. If it's taking this long, then you should just be approving them. Two months is not acceptable. Especially considering some of these claims are worth many hundreds of dollars and some people can't afford to be out of pocket that ******* this case, we'll be out of pocket $500 for more than 6 months at this rate.

  

  Business Response

  Date: 06/11/2024

  At Pacific Blue Cross (PBC), we are dedicated to ensuring the utmost satisfaction of our customers with our products and services. We sincerely apologize for the delay in processing your recent claim, which may have inconvenienced you. The claim that was previously pended for review has been processed.  Our primary objective at *** is to provide exceptional customer service at all times. We trust that this resolution effectively addresses your concerns and lays the groundwork for rebuilding your trust in Pacific Blue Cross.
  

  Customer Answer

  Date: 07/11/2024

   
  Complaint: 22448820
  
  I am rejecting this response because:
  While I appreciate that the claim has been paid, the main issue still has not been resolved.

  
  The website still resets all of the documents when making the claim once the box on the final page has been checked or unchecked.
  Which will cause them to automatically reject the claim, but in three months.

  See attached pictures.

  And the whole process resets itself randomly.

  I just tried again, and getting to the submit claim button on the last page took 2 tries with the webpage automatically loading the default account page randomly and losing all of the information in the claim submittal.

  Sincerely,
  
  **** *******

  

  Business Response

  Date: 26/11/2024

  Dear Member,
  Our IT team is actively investigating the root cause of the issue and will provide an update as soon as the review is complete. Thank you for your patience and understanding.
  Best regards,

• Initial Complaint

  Date:27/09/2024

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I submitted a drug coverage claim in January for a compounded medication. The claim was denied but said pending a letter from a *** confirming the need for the medication this would be reconsidered. I contacted them and they said the only way to submit the letter was by mail.I sent the letter at the end of April by mail. I called many times following up for the next several months trying to determine the status of the claim. I was told it took time to process. I then was told that my letter was never received and to fax it. I faxed the letter and called to confirm it was received. The person then said they don't take faxes. I noted the previous call where I was told to fax the document and then they said they would take a fax. They said it would take something like 40 business days to process. I called again today as now this is impacted the original claims and subsequent ones throughout the year. I was told that they were still processing claims from the start of August. I noted that this claim has been going on most of this year. They said that I submitted the additional form mid-August. I said that I likely would need to make a complaint soon given the very long wait and differing information about processing times.On review today I sent the requested fax in June which was well before August. I just want this issue resolved as it has been very challenging to get a resolution with Blue Cross.

  

  Business Response

  Date: 02/10/2024

  At Pacific Blue Cross, we are dedicated to ensuring the utmost satisfaction of our customers with our products and services. We sincerely apologize for the delay in processing your recent claims, which may have inconvenienced you. Rest assured, we have taken immediate steps to address the issues you raised. The claims that were previously pended for review have now been processed.  Our primary objective at *** is to provide exceptional customer service at all times. We trust that this resolution effectively addresses your concerns and lays the groundwork for rebuilding your trust in Pacific Blue Cross.

  Customer Answer

  Date: 03/10/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.  Additional information about why the pay out was 50% but generally I am happy there is resolution.  
  
  Sincerely,
  
  ******* ******

• Initial Complaint

  Date:06/09/2024

  Type:Customer Service Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On July 17, 2024, I purchased my CPAP and related equipment from a CPAP retailer after receiving a sleep apena diagnosis. I submitted the forms as Pacific Blue Cross explains in their claim information and had everything I needed to be covered. Today, September 6, almost 8 weeks later, I received a notice that my claim was rejected due to a printed receipt obstructing a small portion of the itemized receipt I sent in. Upon further inquiry, I was told I could re-submit these documents unobstructed, but that I would be placed at the back of the queue again and have to wait another 8 weeks before seeing my reimbursement of $2,600. I find this completely unacceptable. I cannot fathom why, after adjusting the submitted documents, Pacific Blue Cross would not complete this claim as soon as possible to finish the job. Extremely disappointed.

  

  Business Response

  Date: 16/09/2024

  Dear Member. Kindly resend the additional documentation through this channel so we can promptly address your request. Thank you for your time and cooperation.

  Customer Answer

  Date: 16/09/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *************************

• Initial Complaint

  Date:04/09/2024

  Type:Customer Service Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Beginning in March of this year, I have sent letters to *** on multiple occasions via multiple methods (fax, mail, in-person drop off, email) asking them to review their decision to revoke access to eclaims on my account. I have called to follow up on this issue and each time they claim they have not received the letter. They take no responsibility or accountability for this and will not allow me to speak to their leadership. Often they put me on hold and hang up on me after waiting on hold for 20 minutes or more. They take no notes regarding my calls and are not able to see how often I have called or how long this issue has been going on for. I have uploaded a copy of one of the letters sent. It was faxed on Aug. 22nd.

  

  Business Response

  Date: 16/09/2024

  Dear Member,
  Upon reviewing your file, we have confirmed that eClaims access was reinstated on September 5, 2024. You can now review your eClaims at your convenience. We apologize for any inconvenience this may have caused and appreciate your understanding.
  Thank you.

  Customer Answer

  Date: 21/09/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***** ******

• Initial Complaint

  Date:14/08/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On July 5, a mail letter from PacificBlue Cross stated that the July 2024 pre-authorized payment in the amount of $175.20 had been returned to our bank for insufficient funds, and gave us two ** numbers that the payment did not go through. On July 23, we made the payment through credit card along with an administration fee, in the total amount of $200.20. However, we checked with our bank as the money was not returned to our account, the bank said the money was successfully deposited to Pacific Blue Cross. When we inquired with one of the representatives over the phone, they told us that we had to email a bank statement proving that the money went through. On August 8, we emailed a copy of the bank statement with the proof that the money went through, a copy of the credit card payment, and the letter we received from Blue Cross. Yesterday, we received their reply stating that according to their records, there were 2 ** numbers that payment did not go through, for us it looks like the person who replied to our email did not even bother to review them in detail in the attachments with the letter you mailed us. The ** numbers provided in their email were completely different from the ones that were stated in their letter and yesterday when we called customer services, they kept mentioning that the payment did not go through and only mentioned the ** numbers provided in the letter. Every time we have contacted Pacific Blue Cross customer services, they have been very unhelpful. They have provided us with different information and they have not been able to clarify the situation. Yesterday the representative (****) said they would call us back with more information but never got back to us. We consider this very unprofessional and incompetent from Blue Cross since we have been dealing with this situation for one month. We find this concerning that you are mailing these letters about payments not going through when they are, for us looks unethical and fraudulent.

  

  Business Response

  Date: 21/08/2024

  Dear Member, we thank you for bringing this to our attention. After further review there were multiple accounts and an error was made.  We have now resolved this matter with the member.  We apologize for the inconvenience that this has caused and appreciate your patience on this matter. 

• Initial Complaint

  Date:08/07/2024

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Pacific Blue Cross continue to provide unbelievably long processing times on claims, including those previously approved that are repeat prescriptions.I have several claims that are still pended, dating back to May 16th. When I called their office, they said they were working on a 47 business day turn around, and are only now getting to claims filed on May 6th. This is abhorrently unprofessional, and with the amount of my unprocessed claims totalling nearly $600, I can now no longer afford my groceries and bills.I have asked repeatedly why these items need to be manually processed, and have been dismissed with saying that that is just their process.My outstanding and unpaid claims are as follows:Claim *********** May 16, 2024 Compounded Preparations $38.33 Status: Pended Claim *********** June 4, 2024 Custom Orthotics $500.00 Status: Pended Claim *********** June 17, 2024 Compounded Preparations $38.33 Status: Pended In today's economic environment, I cannot wait 47 business days to get a total amount of $576.66 back. It forces me to choose between groceries and bills, and because of Pacific Blue Cross' actions, may force me into bankruptcy.I would like the Better Business Bureau's assistance in getting these claims reviewed and paid out, AND, I would like for Pacific Blue Cross to note on its websites the ACTUAL processing times so that people aren't left waiting and calling and calling and getting nowhere.

  

  Business Response

  Date: 18/07/2024

  Dear member, we want to ensure that your claim is processed promptly. The department has indicated that your claims have been processed. Thanks.

• Initial Complaint

  Date:18/06/2024

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been buying pacific blue cross travel insurance for the last 10 years and have no been using it till last Dec when I had stomach problems and needed doctor visits and 1 night hospital stay. I had contacted can assist and they approved my visit. I send all the receipts to insurance. It took them 2 month do process my file and they send a letter to my home address, knowing that I won't be home for another 6 weeks. When I got home more than 4 month have passed and I found out that my claim was denied. It said that they need medical history from attending physician. It is impossible to get more info from ****** since they don't keep any records(not very computerized ) and they are not interested in sending anything by *** at 200 $(since insurance only accepts original reports and mail service doesn't work ). I have all the receipts that show what doctor ordered and the hospital receipt showd exactly all the medications they used. I at least should get reimbursed for bloodtest, xray,prescription and hospital stay,since this is all black and white

  

  Business Response

  Date: 25/06/2024

  Thank you for sharing your feedback with Pacific Blue Cross.  We sincerely apologize for the delay in processing your Out of Country claim. Our standard procedure is to send any communication to the address listed on the claim form. In order to proceed with you claim a detailed letter will be sent by mail explaining the next steps and contact information if you require any assistance. 

  Customer Answer

  Date: 04/07/2024

   
  Complaint: 21866549
  
  I am rejecting this response because:they are supposed to send me an email with detailed info how to proceed with my claim.  It's now 9 days and I haven't heard anything 
  
  Sincerely,
  
  ***********************************

  Customer Answer

  Date: 15/07/2024

  The consumer contacted BBB and stated the complaint has been resolved.