Why do I have to pay a portion of the charge when I go to my Massage Therapist, Chiropractor, etc.?

Your plan is also subject to Reasonable and Customary limits, which are the maximum amounts Pacific Blue Cross (PBC) will reimburse for a specific service or product. These limits are based on the average amount service providers charge in a geographical area. If your provider charges more than these limits, you will be responsible for paying the difference. For more information, please visit Understanding Reasonable and Customary Limits and view the Reasonable and Customary limits.

If you are eligible for coverage under more than one plan, be sure to provide details of the other plan to allow PBC to coordinate benefits, ensuring that the total payment you receive does not exceed your actual expense. Charges must first be submitted to the primary insurer, and any remaining balance can then be submitted to the secondary insurer, up to the reasonable and customary limits.