August 4, 2021

Five common reasons claims are delayed

Five common reasons claims are delayed

To help make your claim experience easier and help you get reimbursed faster, we talked to our claims department about the most common reasons claims are delayed.

1. The receipts were illegible.

With mybluecross® and mybluecross mobile, you don’t need to submit paper claims. However, you may sometimes be required to submit photos electronically or send in photocopies of your receipts or referrals. Double check your submission to ensure none of the information is cutoff or blurry. Missing or partial information can delay a claim.

Some providers will staple the receipts together. These staples can cover necessary information needed for your claim, so be sure to remove them before taking a picture or photocopying.

2. A paper claim didn’t have a signature.

If you do submit a paper claim, double check that you’ve signed it – a missing signature is the most common reason a paper claim is delayed.

Remember – for faster claims processing, you can submit nearly every claim through your mybluecross online account, and submit prescription drugs, vision and health services through the mybluecross mobile app.

3. You provided an invoice – not a receipt.

Invoices and receipts are similar – both show that you’ve received a service. However, a receipt shows that you paid for the service, whereas an invoice simply shows how much the service costs. To process your claim, we’ll need to see proof that you paid for the service.

When submitting proof of payment for a claim, double check to ensure you’ve provided a receipt – not an invoice.

4. A referral wasn’t included.

For benefits like massage or medical equipment, you may need a referral from a qualified professional, such as your family doctor, to be eligible for reimbursement. To prevent a delay, be sure to check if you need a referral before you purchase the equipment or service. You can find a list of your benefits with eligibility information, including referral requirements under View Coverage in mybluecross.

5. You have coverage with another insurer.

Submitted your expenses to another carrier first? We'll need a copy of their statement of payment/denial as well as copies of the receipts to process your claim. Also, if you have Health Spending Account (HSA) coverage, it will be the last payer, meaning your other benefits coverage will be utilized first.

With these considerations in mind, you’re helping us keep your claims experience as smooth as possible.

Plus, if you currently receive claim payments by cheque, get your money even faster by signing up for direct deposit on mybluecross under My Account.

Want more tips to keep the claims process smooth? Learn more here.

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