Dental Benefits Frequently Asked Questions

1. How long does it take Pacific Blue Cross to process my dental claim?

   This table illustrates the estimated amount of time that it takes us to process your dental claim.
   
   

   	Pay Member	Pay Dentist
   Regular Claim	2 weeks	3-4 weeks
   Duplicate Coverage Claim	2 weeks	4-5 weeks
   Pre-Authorization	2-3 weeks	3-5 weeks

2. Can I send dental claims along with my EHC claims?

   You can send your claims in the same envelope. However, it is important that you clearly label your claims for the appropriate department (i.e., Extended Health or Dental).

   Important note: Do not submit a dental claim on an EHC claim form, as it will significantly delay your claim. Dental claim forms are available on your Member Profile, or contact your dental office.

3. How do I submit a dental claim? Where do I get a claim form?

   Your dentist will usually complete the claim form for you.

   If your dental office gives you a receipt instead, submit it along with a claim form. It is important to make sure that all the pertinent information is on the claim form. Incomplete forms will cause payment delays. Click here for a dental claim form.

   Pacific Blue Cross requires this information on each claim:

   • Patient's full name
   • The member's policy and ID numbers
   • Patient's dependent number and birth date
   • If PBC is to reimburse the member, we also need the member's mailing address.

   We also need all the information about the dental services that were performed. This includes:

   • Procedure code
   • Date of service
   • Fee charged
   • Tooth numbers and surfaces, if applicable
   • The dentist's signature or authorization (or attach a receipt)
   • The dentist's name and PBC ID number
   • A note indicating if PBC should reimburse the member or the dentist (for example, write "pay member")

   If the patient has dental coverage under more than one plan, please see our information on duplicate coverage.

   Mail your claim to Pacific Blue Cross, PO Box 7000, Vancouver, BC, V6B 4E1 or drop off your claim personally at 4250 Canada Way, Burnaby (we're at the corner of Canada Way and Gilmore).

   NOTE: Claims submitted after your plan’s claiming deadline are not eligible for reimbursement. Look for your plan’s claiming deadline in your policy booklet, or in your Member Profile under Plan Information. Please ensure you are looking at the correct benefit category (ie Dental or Health).

4. How do I submit a claim for orthodontic treatment?

   See how do I submit a dental claim? as that information also applies to orthodontic claim submissions.

   (1) Submit a treatment plan.
   
   At the start of the orthodontic treatment, the dentist or orthodontist will prepare a written outline of the proposed treatment. This is called a treatment plan. Pacific Blue Cross must have a copy of this in the patient's file before we can reimburse for orthodontic claims.
   
   When your orthodontist gives you the completed treatment plan form, forward it to PBC. Make sure you indicate on the form:
   

   • The member's policy and ID numbers
   • Patient's full name
   • Patient's dependent number and birth date
   • Information on coverage under any other dental care plans. See duplicate coverage.

   
   (2) Submit receipts (or claim forms).
   
   The orthodontist or dentist may give you a receipt instead of completing a claim form. To submit the receipt as a claim, make sure this information is indicated:

   • The member's policy and ID numbers
   • Patient's full name
   • Patient's dependent number and birth date
   • Member's mailing address

   If the patient has dental coverage under more than one plan, please see our information on duplicate coverage.
   
   Click here for a Dental claim form.
   
   Mail your claim to Pacific Blue Cross, PO Box 7000, Vancouver, BC, V6B 4E1 or drop off your claim personally at 4250 Canada Way, Burnaby (we're at the corner of Canada Way and Gilmore).
   
   Please note: We suggest that you submit your claims promptly. Pacific Blue Cross can only pay claims we receive, with correct and complete information, within one year of the service date.

5. How do I appeal a claim decision?

   If you wish to appeal a decision about a recent claim, contact our Call Centre. Often an issue can be resolved by simply providing you with more information about your claim or what is covered by your plan.
   
   If one of our customer service representatives is unable to resolve the matter with you, they can escalate your request to a 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.

6. What types of services do Dental Plans A, B and C cover?

   Plan A covers basic diagnostic and preventative services. This includes examinations, radiographs, basic restorations, root canals, periodontal cleaning, maintenance of dentures, and extractions.
   
   Plan B covers major restorative procedures such as crowns, onlays, veneers, bridgework and dentures.
   
   Plan C covers services related to orthodontics (the treatment used to straighten teeth and align the bite.)
   
   Please note: This information is based on a standard plan. PBC has many non-standard plans. For more information, refer to your employee benefit brochure or contact PBC directly at 604 419-2000 or 1 877 722-2583 (toll-free).

7. Where do I get more information about my plan?

   Visit Member Profile, our online access to plan and claims information for members. Or, see your employer, union or trust and ask for your employee benefit booklet.
   
   For further information, call the Pacific Blue Cross Customer Service department at 604 419-2000 or toll free 1 877 722-2583.

8. My spouse also has dental coverage. Which dental plan should we use?

   People who are covered under more than one dental plan are required to submit their claims to their own plan first. Any remaining balance may be claimed through the spouse's plan.

9. How do I notify PBC of my change of address?

   At this time, address change requests are handled via e-mail or telephone. Please provide us with your old address and new address. We will be happy to assist you in updating your address.

10. How do I submit my COB information?

    It's important to always keep us up to date with your latest coordination of benefits information because it will ensure we adjudicate your claims with your most recent information. The best way to notify Pacific Blue Cross when there are changes to another plan you are also covered under is to tell us when you submit your next claim. Identify in a note the specific detail(s) that changed. Be sure to advise whether the changes apply to your dental plan, extended health plan or both so we can make sure we continue to pay all your claims correctly.
    
    Remember to also update your service providers if they prepare or submit claims to us on your behalf.
    
    Spouse Claims
    When your spouse has a dental plan through another policy holder/employer, the claim should be handled as follows:

    • If your dentist can submit your claim to PBC electronically, you should claim the expense through your primary plan first. You can submit your claim with a copy of the primary explanation of benefits (EOB) to Pacific Blue Cross for the remaining balance.
    • If your dental office does not provide direct billing, and requires you to pay the dentist directly, your spouse should pay for the expense, take a photocopy of the receipts and then submit the original receipts to his/her own plan. Once you receive the EOB from the other plan, you can submit the photocopied receipts with the explanation of benefits to Pacific Blue Cross to claim the remaining balance.

    
    Dependent Children Claims
    For dependent children, the plan that pays first is determined by the birth date of the parents, as follows:

    • If your birth date is prior to your spouse's in the calendar year, your plan is the first payer and your children's expenses must be claimed through your own plan first.
    • If your spouse's birth date is prior to yours in the calendar year, then your spouse's plan is the first payer for your dependent children. In that case, you must pay for their expenses, take photocopies, and submit the original receipts to your spouse's plan first. Any remaining balance can be submitted for reimbursement to Pacific Blue Cross, along with the photocopied receipts and the explanation of benefits from the other plan.
    • The primary plan should be indicated on the top left hand corner of the claim form and the secondary policy and identification number should be indicated at the bottom of the claim form, where it asks "Do you or any other dependant have any other insurance to cover these benefits?"

    
    Total reimbursement between plans will never be more than 100% of the eligible amount in the Pacific Blue Cross Dental Fee Schedule. If you've been overpaid, contact our customer service department immediately.

11. Where do I send my claim?

    Mail all claims and written inquiries are sent to our priority mailing address.

    Pacific Blue Cross
    PO Box 7000
    Vancouver, BC V6B 4E1

    Always remember to include your policy and ID numbers on all correspondence you send to Pacific Blue Cross.

12. Do you return receipts? Do you accept photocopies?

    Original receipts will not be returned. If you have coverage with another insurance carrier please photocopy your receipts prior to submitting your claim to Pacific Blue Cross. You will receive an Explanation of Benefits (EOB) statement for each claim you submit. Members are encouraged to visit their Member Profile and sign up for Direct Deposit and to receive EOB's online. Retain the EOB statement for income tax purposes.
    
    Original receipts are required to process your claim. However, in cases where you submit your claim to another insurance carrier first, we will accept photocopies of the original receipts if you include the "Explanation of Benefits" (EOB) from the other carrier with your claim.

13. Can I get a duplicate copy of a dental remittance statement previously sent to me by PBC?

    We don't provide duplicate copies of Explanation of Benefits(EOB) as our office is not designed to handle these requests. We encourage you to file the original EOB in your personal records.
    
    As an alternative, you should consider signing up for electronic "Explanation of Benefits." Copies of your remittances are stored in your Member Profile from the moment you sign up for the service. As a reminder, a message regarding a new statement is sent directly to your e-mail address providing faster access than if you were to receive by post. As an added feature, you can see a catalogue of your electronic statements whenever you sign into your Member Profile. For more information on registering for this service, go to Member Profile.

14. How do I print an ID card?

    Members can print replacement ID cards by signing in to Member Profile and choosing the option to print your ID card. You will need Adobe Reader installed on your computer.

15. Will PBC reimburse my dental claim via direct deposit?

    Yes. Dental claims can be reimbursed through direct deposit. Go to your Member Profile and sign up. You will need your transit number, branch number and account number.

16. Can I get a copy of the dental remittance statement that was sent to my dental office?

    We are only able to send a copy of the dental remittance to the original individual that submitted the claim. If the dental office submits the claim electronically, please ask your dental office for a copy of the response that is generated at the time of claim submission. For manual claim submissions, the dental remittance statement issued to the dental office has bulk payments with multiple patients. For privacy reasons, we cannot provide a copy of this to a member. Please check your claim history in Member Profile for details of the claim.