Sunlife
I have been in the military for 18 years and contributing to the health plan that the military has for dependants for 14 years. I have 80% coverage and always paid on time (not much choice as the DND takes the money out of your account before you even see it).
After 18 years I was offered a job at a major bank so I accepted and they have a pretty good benefits package so I figured I would take what they paid for which was 30% (nothing out of pocket). This insurance company SUNLIFE is the same as the military goes with and I must say that they are ignorant baffoons.
The first problem I ran into was when I tried to get my daughter some medication at the pharmacy. I went to pay the pharmacist and I informed her that I have two insurance plans and they are both from the same company SUNLIFE for which I should have 100% coverage, she asked who my present employer is as they must be the first to claim and guess what it comes back that the military has to be the first as SUNLIFE has input the wrong employer as the first one to make the claim, so she tries to input the same medication on my military plan first.
Well you can guess what happened – SUNLIFE has this one set up as the second one to claim so I pay out of pocket for this plan and tell her I will sort it out on by a phone call in the morning.
I call sunlife the next morning and they ask which plan I am trying to call about so I tell them both the bank and the military. They proceed to tell me that they can only handle the bank plan as the military is 2 or 3 doors down from them (2 or 3 doors not blocks or buildings but doors 100 feet away) so I ask her to make sure that the bank is my primary benefits provider so when the pharmacist inputs the medication that it will always go to the banks plan first then what every is left owing the military plan will pick up.
I thought this would have sorted everything out but guess what – nothing changed. The next time I had some medication at the pharmacy, I had to pay again but this time the pharmacist called and they told her that everything would be set up for the next time and that I should send in the receipts again and they will process it.
Well guess what, it happened again but this time they sent back a nice letter stating that I had to send it to the other door down the hall (can they not walk 100feet) and they did not send back the receipts so I had to call yet again. This time, they told me they need to get a manager as the receipts got put into another area (I suspect they moved 200 feet away to another department) well finally after I got sent the receipts (4weeks) I sent them into my other provider which is still the same company SUNLIFE and guess what – they tell me I am not covered for that part of my claim but that the other department (100feet away) will cover me for upto 30%. I ask if they can just walk the 100 feet and hand it to the department but they inform me they cant (why is 100 feet too far? You would think that working for an insurance company they would be somewhat physically fit or at least able to walk 100 feet). So I get them back in the mail and send it in again this time to the right department and low and behold they actually pay me for my claim 30%.
So, even though I have coverage for 100% I am only covered for 30%. Ok. I know what you are thinking. The military has set up their own contract with them and the bank set up their own with the same company SUNLIFE so they cover different medication and prescriptions and I agree, but I have set it up with my employer that I have dual coverage with SUNLIFE and I filled out all the proper paperwork so I would not have to go thru this but I am still fighting with them today. If they are the exact same company (listed on the TSX) why can they not punch it into their big computers and figure out that I have two coverages with them. I sent a nice letter to the company stating that it is nearly impossible to make a claim thru them (I was very diplomatic and did not swear or anything) they would not even send me a reply. I actually talked to someone who works for the company in the claims department and he mentioned they try to make it confusing so poor shmucks like me just give up. I am almost to the point where I am giving up, I can fight the Taliban, or in Croatia and never give up but try to fight the insurance companies for money that is rightfully mine will take a coalition of all allies to beat that one.
thanks
Disclaimer
This article was submitted by one of our readers. Penciltrick cannot make any claims as to its authenticity but the article was accepted on a good faith belief that it is an accurate and truthful account of the events listed.