To view the list of delisted providers, please sign in to our member site.
Most health care providers are honest and professional. Unfortunately, there are some who engage in unethical or even illegal activity.
As part of our customer commitment, we protect your plan from abuse or misuse by taking action toward those health care providers who engage in unethical behaviour, including making suspicious claims or practicing illegal activities. Along with adding them to our delisted providers, we may file a complaint with their governing body or even pursue civil or criminal legal action.
When this happens, they may be labelled as a delisted provider. A delisted provider has been removed from our eligible providers list because their behaviour negatively affected a plan member’s benefits plan. Once a health care provider is delisted, all claims for their products or services are ineligible for coverage, payment or reimbursement.
Alberta Blue Cross® reviews and assesses which providers are eligible for coverage of products and services and which are reimbursed or paid for on your behalf through your health benefit plan. Details regarding each health care provider must be kept private and confidential, so if a provider has been delisted, we cannot tell you what they did.
No. This process is consistent with those conducted by many other benefit companies. We are aware that the decision to delist a health care provider has serious consequences for all involved, so we follow strict industry standards and conduct extensive reviews before delisting a provider.
Claims for products or services provided by delisted providers won't be covered or reimbursed through your benefit plan, so if the provider is delisted, you would have to pay the full cost of the claim, even if you didn’t know they were delisted before you saw them.
Before you visit a health care provider, we highly recommend that you sign in to our member site to see if they're eligible for reimbursement. To view the current list of ineligible providers, simply sign in to your member account and click the delisted providers link. You can also search for eligible providers using our direct bill provider look-up tool.
You can also ask a health care provider about their eligibility before obtaining their services, or you can call our Customer Services department at 1-800-661-6995 to ask if that particular health care provider is eligible for Alberta Blue Cross® coverage, payment or reimbursement.
Yes. You are free to continue to request products and services from this health care provider in the future, but please be advised that if you do so, you will be responsible for the full cost of the product or service. The cost will not be paid for or reimbursed through your benefit plan.
Yes. Any Health Spending Account that you have is not affected by Alberta Blue Cross®'s decision regarding this health care provider's eligibility.
No. After extensive review and discussion, Alberta Blue Cross® has determined this provider is no longer eligible for coverage, payment or reimbursement, and the decision cannot be appealed.