Pacific Blue Cross

Step-by-Step Guide to Filing Claims with Pacific Blue Cross

1. Prepare Required Documentation

• Original Receipts: Must include provider name, license number, service date, and total cost. For prescription drugs, ensure receipts show drug name, DIN, and pharmacy details
• Completed Claim Form: Available for download via the Member Profile portal for non-online claims (e.g., custom orthotics, hospital stays)
• Special Cases:
  • Orthopedic Shoes/Orthotics: Requires a physician’s referral and pre-approval
  • Hospital Accommodation: Hospitals in British Columbia can bill Pacific Blue Cross directly for semi-private/private rooms

2. Submit Your Claim

Option 1: Online via Member Profile

1. Log In: Register or sign in to your Member Profile using your policy number or student ID (for students, omit the preceding "V" if applicable)
2. Select Claim Type: Choose from eligible categories (e.g., prescription drugs, physiotherapy, vision care)
3. Upload Documents: Attach scanned receipts (JPEG/PDF/PNG). Claims are adjudicated in real time, with approval visible immediately
4. Direct Deposit Setup: Enter banking details for reimbursement within 48 hours

Option 2: Mobile App

1. Download the Pacific Blue Cross Mobile App (iOS/Android).
2. Use the “Submit a Claim” feature to photograph receipts and submit directly

Option 3: Mail or In-Person Submission

1. Download and Complete Forms: Available in the Member Profile portal
2. Include Original Receipts: Keep receipts loose (no staples or clips) and ensure forms are signed
3. Mail to:
   Pacific Blue Cross
   [Address listed on the claim form]

3. Track and Receive Payment

• Processing Time:
  • Online/Mobile: Approved claims are paid via direct deposit within 48 hours
  • Mail: Allow 7–14 business days
• Payment Schedule:
  • Direct Deposit: Next business day
  • Cheques: Issued on the 1st and 16th of each month

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FAQ: Pacific Blue Cross Claims Process

1. What services can I claim online?

You can submit claims online for prescription drugs, physiotherapy, massage therapy, acupuncture, chiropractic care, vision care, and more

2. How do I coordinate benefits with another plan?

Submit to your primary insurer first. Include their Explanation of Benefits (EOB) when filing with Pacific Blue Cross

3. What is the deadline to submit claims?

Claims must be filed within 12 months of the service date. Check your plan booklet for exceptions

4. Can pharmacies bill Pacific Blue Cross directly?

Yes. If your plan includes "pay direct," provide your policy and ID numbers at the pharmacy. Otherwise, pay upfront and submit receipts online

5. What if my claim is denied?

Common reasons include missing receipts or exceeding coverage limits. Resubmit with corrections or contact customer support at 1-888-275-4672

6. Are mental health services covered?

Yes. Most plans include psychologists (e.g., $500/year). Verify coverage in your policy’s “Extended Health” section

7. How do I update my banking details?

Log in to Member Profile → Navigate to “Payment Settings” → Enter new account information

8. Does Pacific Blue Cross cover travel emergencies?

Yes. For travel insurance claims, contact the 24/7 MEDOC® Assistance Centre (e.g., 1-800-709-3420) and submit receipts post-trip

9. How do I check my claim status?

Use the “Claims History” tab in Member Profile or the mobile app

10. What if I need urgent disability support?

For short-term or long-term disability claims, submit completed employer, employee, and physician forms via email or mail. Payments begin after a waiting period