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.
June 10th, 2010 at 9:00 am
I am considering Sun Life but this complaint is a wake up call. Thanks for letting us know!
July 14th, 2010 at 5:02 pm
Well here is another one for your blog.
This is an email complaint to Sunlife that there call center in Toronto will not respond to as they are not sure as to what to do. I will post there response if I ever get one.
My son started out on a monthly plan for braces one
month. We have been clients of Sunlifes for 4
years. We found a way to pay the whole dental
off the next month but were denied full
reimbursement as we were told “the systems
cannot change the option after the initial
entrance”. We challenged this as Sunlifes
systems are not our responsibility and were told
that if we can prove the appointments are
ongoing we would be reimbursed the full amount
at once. We did this with appointment cards and
again denied as the system could not be
changed. My wife is currently working against
the doctors orders and will eventually have to
take a leave of absence. The reason she has not
taken the leave thus far is because of Sunlife
screwing us around with this dental claim.
Sunlife is currently working against my wifes
health and I have gone to the media with regards
to this, withholding of course for the time
being the Sunlife name. We called again tonight
with regards to this claim and apparently the
systems have lost the previous 4 calls that we
have made regarding this. Now according to Christine a senior representative at this call center she guarentees no calls are lost in her system. My wife works at a call center and if the employee does not hit save or the note taking program times out then nothing about your call is saved. Wow, Christine has perfect employees and perfect systems, maybe she should work for Bill Gates as there is not a computer in the world or employee that works at 100% efficiency, her employees and systems do though. Whatever. Christine says oh no her employees wouldn’t do that. Again tonight we were
told that the payments are made monthly as that
was our original option and the fact that we did
not pay it in full on day one is the reason for
the claim not being paid out in full. We
escalated to a senior agent and were given the
treat of talking to Melanie. Melanie was the
one who informed us that we never called on this
claim according to there system and that the call center agents are providing false information by saying that “we have supplied all the correct
information and the reason the claim is not
being paid out in full is because there is a
glitch in the system that will not allow the change to occur”. Melanie consistently states a different
story. The agents are incorrect, she has
nothing on file for anyone saying anything and
if my wife takes her leave then the claim will
not be paid even though she has paid for the
last 4 years and currently paying. Interesting
new twist Melanie has added. I asked Melanie if
she has all the information in front of her with
regards to what we sent in, she said yes. When
I asked her to read the dates on the cards that
were sent in to prove that the treatment is
ongoing, she then said did not have the
information in front of her but could get it if
she needed it. Again more lies on behalf of
Sunlife. I asked why would we have bothered
sending all of this numerous times if your
agents did not tell us this. Melanie stated it
does not matter what we were told as it was
incorrect, what matters is what is written on
the claim return. I pushed the fact that we were
told by numerous agents not what she was saying
and we have been callng since January so we
could make a decision before we had the
orthodontics put on. Melanie then asked in a
condescending way if I can read. I said no I
cannot. She then went on to her agents wouldn’t
say that. Again I said why would we send all
this in if we did not call and were told to if
your agents said anything different. She just
kept saying if I could read I would see on the
statement. I am visually impaired, I am sorry
that I cannot read what you have typed in small
letters. According to Melanie that is not her
problem and agents can say whatever to get them off the phone fast and take another call as they are paid on a per call basis.
This is one call that will be escalated directly to Sunlife as I rely on these agents due to my impairment and trying to get a variable number of calls in to get raises or bonuses is not an option when dealing with someone like myslef. I need to
talk to an agent of Sunlife who has an education
to be a little more than robotic and understands
the limits of those of us visually challenged.
The dealings I am having is unacceptable and I
will be calling back the radio show with regards
to how Sunlife is dealing with this and
including there name if not handled with
satisfaction. Numerous callers have responded
to this and we would all like to know the
following. Others have had the claim paid out
in full when they paid upfront and others even
when paid off so what is the difference with our
claim, has the system software been changed?. The monthly option is only if you pay monthly and once you stop paying monthly the claim is paid out in order to get the event case closed. An orthodontist who apparently deals with Sunlife regularly said he is willing to give me receipts stating the treatments have already been done. So is this acceptable?. Who
is the company that is scamming us on our claims after 4 years of paying in so others know who to be
weary of? I can answer that one very easily for
them, so no need to respond. How does Sunlife
feel that visual impairment in todays society is
no concern when they know I cannot read as I
made it clear an they just keep saying read my
statements as that is what matters? Why are we told one thing by numerous agents but yet none of these calls can be traced when we state that we were told
differently on the phone? Also, I now know this
is a contracted company paid to give runarounds
to clients but I am told to ask for a
representatives number at Sunlife so this can be
clarified and made public to all who may be
contemplating Sunlife benefits in the future.