Consumer Complaints and Resolution Process
At Pacific Blue Cross, we do our best to ensure plan members are satisfied with the products and services we provide. We do this by providing caring service within the rules established by the policy that was purchased. If you are dissatisfied with a decision or service related to your extended health, dental, life, disability or travel insurance plan, you may have the situation reviewed. Please follow the steps listed below:
- First, discuss your concern with the person or department involved.
Claims and Contract Issues:
Many issues can be resolved by simply speaking with a customer service representative. Disputes regarding claim payment or benefit eligibility should be directed to our customer service lines at 604-419-2000 in the lower mainland, or toll-free at 1-877-PAC-BLUE (1-877-722-2583). You can also send us a message. Once in contact with our customer service center, the representative will be able to provide you with a timeline to seek resolution. Most claim issues can be resolved within 5 business days.
If your complaint involves a suspected privacy breach, please contact the previously mentioned numbers or direct your correspondence to:
Chief Privacy Officer
c/o Pacific Blue Cross
PO Box 7000 Station Terminal
Vancouver, BC V6B 4E1
- If your concern is regarding a recent claim or benefit eligibility and one of our customer service representatives is unable to resolve the matter with you, they can escalate your request to their internal leadership team, and/or our Benefit Review Committee for further review. They will explain how to file your appeal and help you to provide all relevant information regarding your claim.
Once the Benefit Review Committee receives the details of your complaint, they will conduct a review with the appropriate department. Please ensure you include all pertinent details regarding the complaint including your name, policy and ID, the nature of the dispute, with whom you have discussed the issue and why you believe your situation has not been handled appropriately. The benefit review committee is comprised of subject matter experts and department leaders who will review the dispute and determine what actions are needed, if any. Once the review is completed a representative from the benefit review committee will respond with the results of the review and the departmental response or proposed resolution to the complaint. This step will be completed within an average of 10 business days.
- If you remain dissatisfied with the results you may choose to escalate to the Complaint Officer at Pacific Blue Cross. The role of the Complaint Officer is to conduct an independent review into all the facts of the dispute and present the company’s final position on the matter. The Complaint Officer is responsible for ensuring the appropriate steps in the escalation process have been followed. The Complaint Officer also manages inquires or requests from our regulator and the Ombudservice for Life and Health Insurance regarding complaints under their review.
Please print and mail or fax your completed Complaint Form* to:Complaint Officer
C/O Pacific Blue Cross
PO Box 7000
Vancouver, BC V6B 4E1
Fax 604 419-2092
After sending all the pertinent information, documentation and steps you have taken to resolve your dispute via mail or fax to our Complaint Officer, you will receive an acknowledgement of receipt within 5 business days. The Complaint Officer will then conduct a review and respond to your dispute by mail to the address PBC has on file within 60 business days. If a complainant has not followed the internal department’s escalation process, the dispute will be assigned to the appropriate department to resolve. Should a resolution not be reached, the complaint will be escalated to the next appropriate authority in the escalation process. The Complaint Officer will not review complaints that have not first been escalated to internal department leaders.
At all times throughout the complaint handling process you may contact the Pacific Blue Cross Complaint Officer for any questions or comments related to this process by mail or fax as shown above.
*We are working to create a version of this form that can be submitted online. At this time, we are only able to receive paper copies of this form. We thank you for your patience and understanding.
- If you continue to remain dissatisfied after following the Company’s internal complaint handling process and wish to pursue your dispute, you may request a “Final Position Letter” from the Complaint Office at Pacific Blue Cross, which will have the company’s final position on the matter and details of the next steps available to you in order to further dispute Pacific Blue Cross’s handling of your complaint. Final Position Letters will be acknowledged and sent within 5 business days. You may then contact:
The OmbudService for Life & Health Insurance (Ombudsman des assurances de personnes in Quebec), for issues with Individual Product insurance.
In Toronto 416-777-9002 In Montreal 514-282-2088 Toll Free across Canada 1-888-295-8112 Toll Free in Quebec 1-866-582-2088 Toronto Fax 416-777-9750 Montreal Fax 514-285-4076
Individuals with hearing loss can contact us via the free Bell Relay Service at 1-800-855-0511.
OmbudService for Life & Health Insurance
401 Bay Street, Suite 1507
PO Box 7
Toronto, Ontario, M5H 2Y4
Ombudsman des assurances de personnes
2001, rue University
Montréal Québec H3A 2A6
Please note the OLHI Ombudsman is not able to assist with issues related to benefits provided through your employer or if a regulator is already involved. The OLHI ombudsman also only deals with consumer complaints. For more information on the process please see the “Complaints” section of the website https: www.olhi.ca or https://oapcanada.ca/.
Concerns about Pacific Blue Cross’s conduct may also be directed to our regulator the British Columbia Financial Services Authority at:
BC Financial Services Authority
2800 - 555 West Hastings Street
Reception: 604 660-3555
Toll Free : 866 206-3030
Fax: 604 660-3365
Issues that can be brought forward to BCFSA include:
Sales and marketing practices, insurance company complaint handling and dispute resolution procedures, and insurance contract issues. BCFSA more generally ensures that insurers do not engage in acts and conduct that might reasonably harm the interests of insureds.
The BCFSA does not generally intervene in individual claims disputes between policy holders and insurance companies.
For complete information on what BCFSA can assist with, please see their website at https://www.bcfsa.ca/index.aspx?p=fid/index#ins. A complaint form is available at https://www.bcfsa.ca/pdf/FicomForms/InsuranceComplaintForm.pdf