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: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.

   
  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,
  
  ***********************************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: 15/07/2024

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

• Initial Complaint

  Date:17/06/2024

  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.

   
  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,
  
  *********************************along with documentation. It is unclear in the email as to what portion they are asking for and the email includes this statement that it may be rejected if its sent online in which case I should call them! This claim is in the $200 plus range - a not insignificant amount for a senior on a limited income.It seems like Blue Cross is just giving me the run around and not one of their customer service reps has shown the least interest in helping me. Once again- these are all medications zi have taken for years at regular intervals. I should not have to send in another claim and wait for goodness knows how long to be reimbursed.

  

  Business Response

  Date: 25/06/2024

  Dear Member. We wanted to inform you that your claim has already been processed. Please don't hesitate to reach out if you have any questions. Best regards,

• Initial Complaint

  Date:14/06/2024

  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.

   
  Complaint: 21847942
  
  I am rejecting this response because:

  The original claim was submitted in December of 2023. It takes PBC too long to process claims and they keep wanting additional information that I have to submit and wait ***** business days for a response. PBC recently contacted me to to tell me that the documentation I sent in had the top cut off. I disputed the assertion as the agent confirmed to me that she had received the documentation in full. PBC then agreed that everything was intact and I would have a response shortly but they were about a week out from my submission date. I reiterate that my claim is for a refill of a prescription that they already had covered. Nobody at PBC can see how ridiculous this scenario is. To drag a claim out for over 6 months is beyond the comprehension of a reasonable person.
  
  Sincerely,
  
  *******************

  d my PBC plan shows that the prescription is 100% reimbursable. This has been going on for over 6 months now. The ridiculous part is that PBC paid for the original prescription and are dragging their heels on paying for the refills. All the agents do is apologize and tell me how backed up they are. If that is the case hire more people and stop putting pensioners in the position of financial hardship. There is currently issues with my plan sponsor and PBC and please note this all happened well before those issues began.

  

  Business Response

  Date: 25/06/2024

  Dear Member. We sincerely thank you for your patience. We received your updated statement from the *************************** on May 3rd. Due to the processing backlog, we haven't reached that date yet, which is why your claim history still shows the results from April 29th. Rest assured, we will update your claim history as soon as we process your submission. Best regards,

  

  Business Response

  Date: 03/07/2024

  Dear Member,
  PBC has provided the requested information in previous communications. If you need to escalate this matter, please follow the complaints process detailed at the following link: ******************************************************

  Customer Answer

  Date: 03/07/2024

   
  Complaint: 21847942
  
  I am rejecting this response because:

  PBCs previous message was disingenuous as it did not address the matter at hand; which was the extraordinary time (over 6 months) to pay my claim. Please note, the claim has since been paid out in full. To enter into their internal complaint system takes longer to process than it did for them to pay me. I have a complaint in on another matter with them and there has been no correspondence since acknowledging receipt of the complaint  almost 2 months ago.
  
  Sincerely,
  
  *******************

• Initial Complaint

  Date:14/06/2024

  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.

   
  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,
  
  ******************* now have no way to refile for reimbursement. My credit card will not re print receipts and the blue cross will not accept the pharmacy reprinted receipts. We have followed all instructions and process and are still denied. I fear my mom's 800 plus dollars is now list as all we have for proof is a printed receipt from the pharmacy which the blue Cross will not accept. They offer no complaints process, no manager, no ombudsman. They aren't regulated by anyone. We are running low on medication and cannot get more without reimbursement. This is unfair and a clear violation of human rights in taking advantage of my mom's memory problems. We need help.

  

  Business Response

  Date: 20/06/2024

  Thank you for sharing your feedback regarding your recent experience with Pacific Blue Cross. We have taken immediate action to address the concerns you raised and have recently reached out to you with a resolution.  At Pacific Blue Cross, we are committed to providing our members with exceptional service and a quality experience. Your input is invaluable to us as we strive for continuous improvement.

• Initial Complaint

  Date:27/05/2024

  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.

   
  Complaint: 21764638
  
  I am rejecting this response because:

  I do not want to file a complaint with the BBB every time I need my claim looked at. 

  PBC makes claims, falsely, on their website as to the time determination of processing claims. 

  Until they change those statements, publicly, or fix this issue (it's been ongoing for at least 8 months) I will not accept this boiler plate response as a resolution. 
  
  Sincerely,
  
  ***********************

  y are a non-profit and they are short staffed. I was also told that it would be faster for me to send in my claims by mail. I eventually convinced them to review my claims and reimburse me. They did at that time.This trend continued into the end of May, when I had another three claims to the tune of $551.25. (They are now reimbursing at $170.) I cannot afford to carry this balance, which is why I PAY for extended health. As well, a simple ****** search and a look at BBB complaints, will show this has been ongoing since at least Nov 2023 and its always with therapy. When I called the second time, I was told "as a favour to me" (since Im suffering financial troubleswhich was condescending at the least) they would put through ONE of my claims. This business practice of claiming online they can put through claims within 48 hours but really taking two and a half months needs to stop. Consumers deserve the service they are paying for and PBC needs to fix this ongoing issue.

  

  Business Response

  Date: 31/05/2024

  
  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. 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 PBC 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: 10/06/2024

   
  Complaint: 21764638
  
  I am rejecting this response because:

  The messaging from Pacific Blue Cross on turnaround times is not clear that it is only for claims beneath their unreasonable and outdated caps on healthcare and misleading a consumer with technically true statements is unacceptable. If a provider submits a claim above the maximum that claim is processed immediately by the systemthis 2 and a half month turnaround time is only for those paying premiums and not using a provider that submits directly or charges an outdated fee. 

  Pacific Blue Cross continues to claim they are working on a solution but can never provide any specifics as to what that might be and this has been going on since at least November 2023. Any reasonable person would except a solution to have been in place by now. 

  I will be satisfied when a solution is in place and the turnaround is a reasonable--as compared to other extended health providers. Or, Blue Cross needs to be transparent on their website and state that while claims meeting their threshold and those submitted by providers directly may be 48 hours, those submitted by members whose practitioner does not direct bill and charges an amount closer to industry standard will wait a minimum of 2 and a half months for reimbursment.

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

  

  Business Response

  Date: 07/06/2024

  At Pacific Blue Cross (PBC), we are dedicated to ensuring your satisfaction with our products and services. We sincerely apologize for the delay in processing your recent claims.  Our online messaging indicates payment within 48 hours for approved claims.  The delay youve experienced occurred because the amounts claimed exceeded the reasonable and customary limits, necessitating a review. We have several initiatives in progress to expedite our processing times. Our team is working diligently to enhance efficiency and streamline our processes.We are committed to improving our turnaround time and providing you with exceptional customer service.

  

  Business Response

  Date: 20/06/2024

  Thank you for sharing your feedback with Pacific Blue Cross.  We sincerely apologize for the delay in processing your recent claim.  We understand the importance of timely service.  As shared in our previous response, we are actively working on several initiatives to enhance our efficiency.  We appreciate your patience during this time.  Pacific Blue Cross is committed to improving our turnaround times and delivering exemplary customer service.

  Customer Answer

  Date: 23/06/2024

   
  Complaint: 21764638
  
  I am rejecting this response because:

  Receiving a boiler plate response to a BBB complaint shows the insincerity of Pacific Blue Cross and that they are not concerned with customer satisfaction. They continue to use buzz words and stock phrases rather than admit they are waiting for customers to consider a minimum of 2.5 months wait for reimbursement to be business as usual.

  To note: I have just submitted another claim for $183.75. Of that, I will be reimbursed $170 AFTER waitinmg a minimum of 2.5 months. In 15 buiness days, I will submit another claim making my burden of debt $340 ($170*2). In 30 business days from now, I wil submit another claim for the same amount making my burden of debt $510 ($170*3). Between that claim and my next claim, PBC will reimburse me for the FIRST claim at $170, maintaining my burden of debt between $340 to $510. All of this for a service I pay for twice a month, on time. 

  This continues to be unacceptable regardless how many times PBC claims to be dedicated to customer service and no matter how often they send a boiler plate apology (I received the same response via email from them when I first complained directly to them). I will not consider this resolved until either:

  1) PBC fixes the issue and there is a 5-10 business day wait on claims as is the industry standard.

  2) PBC publicly states on their website that all claims requiring review are subject to a minimum 2.5 month wait (equal to 30 business days).

  3) PBC loses its BBB standing. 
  
  Sincerely,
  
  ***********************

  

  Business Response

  Date: 03/07/2024

  Dear Member,
  PBC has provided the requested information in previous communications. If you need to escalate this matter, please follow the complaints process detailed at the following link: ******************************************************

  Customer Answer

  Date: 03/07/2024

   
  Complaint: 21764638
  
  I am rejecting this response because:

  PBC is not addressing my concerns. I will not adrress this internally with PBC to be ignored. I attempted that before bringing this up with the BBB. 

  Please see my previous correspondence on how this can be resolved. 

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

• Initial Complaint

  Date:24/05/2024

  Type:Product 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 applied a month ago for Pacific Blue Cross coverage. When I didn't hear back from them by May 22, I reached out to them and told them to cancel my application by May 23. On May 23, a salesperson named ***** phoned and tried to sell me a plan. I told him I'd get back to him with a decision. Then today, May 24, I was contacted via email by a mysteriously named **********, (Member Administrator, Individual Plans) who told me my welcome package was mailed on May 8 and my plan would start on June 02. I received no communication from Blue Cross other than these interactions. I immediated emailed **** L twice, and I've also tried to phone her at the 2 numbers she said to reach out to her at. Not surprisingly, I wasn't successful. I am pretty certain Pacific Blue Cross has treated me in a sneaky, thieving and underhanded fashion in order to collect premiums. I don't want their policy and I told them that before they let me know they had accepted me.

  

  Business Response

  Date: 31/05/2024

  Dear member,

  On May 6, 2024, an application was completed online for a policy effective date of June 1, 2024, with the first payment scheduled for withdrawal from the credit card on that same date. The policy was issued promptly. On May 8, 2024, the Welcome Letter, Contract Letter, Contract Booklet, and ID cards were mailed to the address provided during the application process. Subsequently, on May 24, 2024, we received an email from you requesting plan termination, which was promptly executed on May 28, 2024. Since no funds were withdrawn from the credit card, no refund is owed.

   

• Initial Complaint

  Date:15/05/2024

  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.

  Currently have two plans under PBC. My primary plan being: Policy #: *****, ID #: ******** My secondary plan being: Policy #: *****, ID #: **********. The primary being administered by StudentCare, and the secondary which I am dependent under. I have multiple instances of a medication covered by my secondary plan that at first wasn't covered by my primary plan but now is. On April 19th, I called PBC regarding this, and was told to contact StudentCare. On the same day I called StudentCare and was in contact with *****, a Service Manager, and was told to RESUBMIT online. The Claim IDs being *********, *********, and *********. All 3 claims were instantly rejected after submitting, and as a result I had immediately called StudentCare and spoke with ***** to ask why. I was told that internally the claim was still "processing" and after 2-3 business days contact back for further information. 5 business days pass and nothing has been has changed. After a few more days, I submit an online contact form for further information, and to get in writing confirmation of all the information that I was told. 2 weeks later and I have not heard ANY information from StudentCare. DO NOT tell me to contact StudentCare, DO NOT forward me elsewhere. Regardless of who/how the plan is administered it should NOT be my responsibility to chase after reimbursements for a drug that I AM COVERED for. It is predatory to give "coverage" on medications that I REQUIRE to live but refuse to reimburse my expenses on EITHER plans that provide "coverage" for. I do not have the time nor energy to further pursue something that I am entitled to when I pay for my insurance plan.In addition, I have claim IDs ********* and ********* that I have coverage for under my secondary plan. Claiming "This claim is not paid as the maximum amount allowed for this procedure is covered by the primary plan" on my secondary plan when the primary plan did NOT pay for my coverage is extremely misleading.

  

  Business Response

  Date: 21/05/2024

  Dear member, the particular department tried calling you but were unsuccessful. We sent a correspondence. Thanks for contacting PBC.

• Initial Complaint

  Date:08/05/2024

  Type:Billing 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.

  
  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,
  
  *****************************king days to be assigned. On 02.21.24 the Hospital contacted me requesting final payment as they had not heard from PBC & needed to close their file. Final payment I/A/O of $6000. USD was made by my credit card. PBC advised I mail an addendum & include hospital receipt. Have called PBC weekly or bi-weekly & I get different responses. Have spoken to reps who were polite and others who were rude. 04.25.24, advised that claim had been forwarded back to a ********* to rule out pre-existing. I don't understand why it is being returned to ********* when they have closed their file. It's been 13 wks since ********************* still waiting for payment. It's extremely frustrating & disheartening when you do everything that is requested & still get no resolve within a reasonable **** of time. I feel I am being held hostage & life is on hold until I receive reimbursement I/A/O $20933.58 Cndn Dollars. I am seeking your assistance to help get reimbursed for the full amount owing.

  

  Business Response

  Date: 15/05/2024

  Dear Member, 
  

  The claim department has been been actively working on this file for a few days. This file will be resolved and the payment will be sent in the next few days. 

  Thank you

• Initial Complaint

  Date:02/05/2024

  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.

   
  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,
  
  ***********************.I can appreciate that things take time, but I am tired of waiting this long, having claims held with no explanation, and waiting for "this week" and "next week" to go by without any resolution.

  

  Business Response

  Date: 09/05/2024

  Dear member, as a follow up the claim has been reviewed and process. Thank you.

• Initial Complaint

  Date:30/04/2024

  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.

  Submitted claim in January 21 202,in written form. Have called 6 times to find out why it has not been paid. After the last 3 calls I have been assured it would be paid within 2 to 3 days. Why can I not speak to someone with authority to pay this. I'm tired of the constant run around. Will someone please do their job.

  

  Business Response

  Date: 02/05/2024

  Dear Member,

  I have contacted the specific claims department, and they are currently reviewing your claim. Rest assured that it is receiving attention. We appreciate your patience in this matter. Thank you for your understanding.