Dental Frequently Asked Questions

1. How long does it take Pacific Blue Cross to process my dental claim?
   
2. Can I send dental claims along with my EHC claims?
   
3. How do I submit a dental claim? Where do I get a claim form?
   
4. How do I submit a claim for orthodontic treatment?
   
5. What types of services do Dental Plans A, B and C cover?
   
6. Where do I get more information about my plan?
   
7. My spouse also has dental coverage. Which dental plan should we use?
   
8. How do I cancel or add someone to my plan?
   
9. Where do I send my claim?
   
10. Do you return receipts?  Do you accept photocopies?
    
11. Can I get a duplicate copy of a dental remittance statement previously sent to me by PBC?
    
12. How do I obtain an ID Card?
    

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 here, 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).
   
   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.
   
   
   
   
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 nstead 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. 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.
   
   
   
   
6. Where do I get more information about my plan?
   
   Visit CARESnet, 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 604 419-2300 or toll free 1 888-275-4672.
   
   
   
   
7. My spouse also has dental coverage. Which dental plan should we use?
   
   Many families have dental benefit coverage under more than one plan (usually when each spouse has his or her own coverage through an employer). If your employer allows it, you may submit claims under both dental plans.
   
   To submit claims under more than one plan: Indicate both policy and both ID numbers on the receipt, or submit two receipts. Indicate both policy and both ID numbers on each receipt.
   
   PBC uses the following Canadian Life and Health Association (CLHIA) guidelines to determine payment:

   Employees and members

   • The plan where the person is covered as a member
     
   • If a person is a member of two plans, priority goes to:
     
     (a)  the plan where the member is an active full-time employee
     (b) the plan where the member is an active part-time employee
     (c)  the plan where the member is a retiree

   Spouse

   • the plan where the person is covered as a dependent spouse

   Dependent children

   • The plan of the parent with the earlier birthdate (month/day) in the calendar year
     
   • The plan of the parent whose first name begins with the earlier letter of the alphabet, if the parents have the same birthdate
     
   • In situation where the parents are separated or divorced, the following order applies:
     (a) the plan of the parent with custody of the child
     (b) the plan of the spouse of the parent with custody of the child
     (c) the plan of the parent not having custody of the child
     (d) the plan of the spouse to the parent in (c)

   Other situations
   If priority cannot be established under these guidelines, Pacific Blue Cross will divide payments equally between the insurance carriers (50% paid under each plan).
   
   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.
   
   
   
   
8. How do I cancel or add someone to my plan?
   
   Contact your benefit administrator at your employer, union or trust in order to complete a change card, and forward it to Pacific Blue Cross.
   
   
   
   

9. 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.
   
   
   
   
10. Do you return receipts? Do you accept photocopies?
    
    For dental claims, you may send us photocopies of your receipts. Unfortunately, we are unable to return receipts.
    
    
    
    

11. Can I get a duplicate copy of a dental remittance statement previously sent to me by PBC?
    
    Yes. However . . .
    
    At Pacific Blue Cross our top priority is to process your claims quickly and so the staff are busy working on your claims. Our office is not designed to handle requests for duplicate remittance statements. Therefore, we encourage you to file the original statements in your personal records.
    
    As a service to our clients, we will take your request by telephone if you only need one copy. If you require more than one copy send your request in writing to the Dental Department. To help us fulfill your request, make sure you give as much detail as possible, including:
    • the policy, ID and dependent numbers
      
    • the statement dates
      
    • the reason for the duplicate copy
    At this time, we do not charge for this service.
    
    
    
    
12. How do I obtain an ID card?
    
    Visit CARESnet to download a copy of your ID card. To obtain a hard copy of your ID card, fill in the "Request an ID Card" form on our website, or calling the Pacific Blue Cross Member Administration department at 604 419-2900 or toll-free at 1 888 275-4672.