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:25/10/2022

  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.

  I received a copy of of my pharmacist review claim between 2018- 2021.
  It stated that Blue cross considered a number of my prescriptions covered to be "benefits" . Had Blue Cross audited themselves and revealed to consumers that they do not cover compounded prescriptions, it would not have come as such a shock to receive an invoice stating that I pay the back tracked invoices. The pharmacist is covering the expenses now but if I do not pay him, then he foots the bill. This is a sloppy, unprofessional approach to which once was considered "better" medical coverage. Blue Cross needs to explain how they can retrace and demand payment for something they covered. I am holding out on paying the full amount to the ******** ****** until they explain to the pharmacist and his customers why they are doing this now. Are they doing this to all those who used compounding services or are they picking on smaller more rural locations in hopes of dodging their responsibility in this matter. Why don't they try it in TO?
  
  I owe 737.91 . I understand there are others. Not everyone will write but word of mouth carries weight.
  I will send my invoices if required. I am not super technical .

  

  Business Response

  Date: 27/10/2022

  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 the claim(s) you have referred to were paid according to your
  plan design.  Our Customer Service Representatives are pleased to go over
  any questions you may have. Thank you for reaching out.

  Customer Answer

  Date: 30/10/2022

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:
  

  It doesn't give me a phone number or who to speak with.  When I called to ask before I received the BBB response.  I would like to speak with someone who understands why the plan didn't detail , no compounding and also to prevent the pharmacist from filling the prescriptions.  It isn't  enough to have it in fine print somewhere in the internet info.  It would be a simple , human communication tool, to let the pharmacist know once you see compounding is being covered for a number of years.  That is Blue Cross responsibility to inform

  comsumers.  Why wait for years to let both parties know.  

  
  Sincerely,
  
  
  
  ******* *********.  

  

  Business Response

  Date: 07/11/2022

  Please note that our Claims Services Assistant Manager, Minh N***, has reached out and left a few voicemails. If you have any additional questions, feel free to reach out to our call centre at 1-877-722-2583.

  Customer Answer

  Date: 08/11/2022

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:  it is unfair and both the customer and pharmacist would have been warned that compounding prescription drugs is not something they cover.  It seems they only cover large drug companies?

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

• Initial Complaint

  Date:16/08/2022

  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.

  Purchased Travel Medical insurance from Pacific Blue Cross as I have done over the last 10 years. I had 2 weeks of travel insurance from the previous year. I purchased new travel insurance to take over when the previous one ended (December 4- April 15, 2022). I had a medical emergency in January of 2022. Phoned Medi-assist to get claim number and was given one and was advised *** is direct pay, so just provide claim number to doctors/hospital. Returned to Canada 36 hours after insurance expired. *** refused to pay for claims stating I did not have insurance for trip entirety and they do not top up claims or provide coverage if you have other medical insurance. I appealed their decision all the way down the line. *** closed off file so that even the ********* could not investigate the issue. *** refunded insurance cost (cheque not cashed) stating *** would not have provided coverage in this situation. Investigations have debunked all reasons provided by complaint officer. *** has denied claims in the amount of $70,000 Cdn dollars. I had purchased medical travel insurance in good faith like I have over the years. *** has comes up with any reason not to pay. *** is not being fair and reasonable. I paid for coverage, so why shouldn't they cover me. Their own Travel contract debunks reasons for denial, but the complaint officer refused to acknowledge same. *** customer service personnel provided evidence to debunk *** complaint officer reasons for denial. Complaint officer would not communicate with customer service stating "File is Closed". I have the documented evidence to show that the denials are incorrect. *** advertises "Peace of Mind' when purchasing travel medical insurance with them. I thought that too! Now I am left with a huge medical bill in the USA and *** just wiping their hands clean of this. I will not let this happen, even if it means Supreme Court of Canada, BC Financial Service and Insurance Council of BC. PBC, do the right thing and pay the claims.

  

  Business Response

  Date: 17/08/2022

  Pacific Blue Cross
  has an escalation process that is in compliance with all of our regulators. We
  take complaints very seriously, and apply a high degree of scrutiny to each
  case. While we cannot discuss specifics in this forum, we are confident that
  the processes that we have in place, and the resultant outcomes, are in
  accordance with the expectations of our regulators.

  Customer Answer

  Date: 19/08/2022

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:

  This response looks to be a 'copy/paste' reply which does nothing to address my concern.  I'd like a fair and reasonable response from PBC which is only going to happen if a third party is able to review the matter.
  
  
  
  Sincerely,
  
  
  
  ***** ******

  

  Business Response

  Date: 22/08/2022

  There is no new information included in the BBB complaint
  of which we were not aware when we provided our Final Position Letter.
  Unfortunately, during the sales process, the member made a misstatement in an
  online application, and purchased insurance for which they were not
  eligible.  Our resolution, as obligated under the Insurance Act, is to
  refund their premiums in full, which we have done.  We have also provided
  the member with a letter providing next steps in the matter, which we are also
  obliged to do according to our industry’s compliance standards. We
  are happy to participate in arbitration, however we cannot change our position
  at this time.

  Customer Answer

  Date: 22/08/2022

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:
  There was no misstatement in the online application.   At no point did I have two insurance policies in play.  The PBC policy started when the previous policy ended.  The only second policy active would be BC Health Insurance, whom PBC works with.  I was therefore not 'ineligible' for my purchased policy.  I was the one who suggested that if not eligible, shouldn't I get a refund!?  PBC sent me a cheque that I have not cashed.  I also suggested my husband should also get a refund if I was getting one.  He has not yet gotten a refund.  PBC requested his banking info but haven't yet been given it.

  I did receive a letter but that does little to address the original problem, PBC is not being fair nor reasonable and are looking for any reason not to honour my claim after all, "Pacific Blue Cross Cares"!

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