Great West Life and the “orthotics case fee”- Who knew?
I thought I would share my tale of woe regarding orthotics. I am now that person who looks for shoes that these rafts will fit into because I want to walk comfortably for as long as I possibly can. Oh, for the days of careless grace and function.
I sent this letter to the Ombudsperson at Great West Life on March 31, 2016. I find that GWL is wonderful for reimbursing things like my prescription drug costs, osteopathy and physiotherapy fees (up to the limit, of course), dental, eye exams and glasses. I am, therefore, flummoxed by this one. Why are feet different?
Dear GWL Ombudsperson,
On June 24, 2015, I submitted an inquiry to Great West Life via your website’s contact form. I wrote:
“I am writing about an orthotics claim for my son. Once again I submitted a claim that should be covered well beyond the $450 I received. I submitted all the information GWL deems necessary to get the full amount. Please send me a check for the difference.
“I note that I indicated on my claim form that GWL check my file with them before reimbursing me for less than I should receive (letter dated Dec 10 2014). I now plan to share my experience of GWL’s shoddy behaviour with anyone I know, including other employee groups on campus.”
I note that I have had to write numerous times in the past to get the full reimbursement of over $600 for two prior claims, which I did ultimately receive because I submitted what you required. The first time took 5 months and diligent follow-up (claim submitted in September 2013 and full reimbursement received February 2014). The second time took only one month, but still required diligent follow-up by me. I felt sure you would get it right in June 2015 without need for follow-up, but I was wrong.
I received what looked like a real person’s response on June 25:
“Thank you for contacting Group Customer Contact Services at Great-West Life.
“I am currently looking into your inquiry and the paperwork submitted. I will contact you within 2 business days.
I followed up 68 business days later, October 2, with a reminder email. On October 5 I received a message saying the following message:
“I apologize for the delay in my response.
“I have reviewed your coverage and claim.
“As an insurance company, we must assess a client’s claim based on the terms of their group benefit plan. Based on the terms of your Great-West Life plan, custom made foot orthotics are covered to a maximum of $450 per pair.
“To discuss your plan design further, please contact your plan administrator.”
To which I replied the same day:
“Is this a recent change, X? If so, please send me the documents that announce it, otherwise I know it not to be true. The reimbursement amount for all that is covered, fees and orthotics, can exceed $600 in total. I suggest you look in my file with GWL as I have dealt with this issue twice before in 2013 and 2014. You will find correspondence with or copied to A, B, C, and D.”
Interestingly I received the following message on October 8:
“Good morning Ramneek,
“I am currently looking into your inquiry and your previously assessed claims. I will contact you within 2 business days.
This time it really seemed like a real person. And yet, since then, silence.
It is now April 1, over 100 business days later. Could you kindly send me my money?
Just so you know, I plan to put this letter and any response I receive into the union’s newsletter.
I received a letter dated April 14 from GWL’s Customer Liaison. Apparently the examination must include an “orthotics case fee” and this must be noted on the submitted receipt to get the full reimbursement possible. Who knew? My receipt did not have this written on it, although an earlier one I submitted from the same doctor did. Even so, GWL figured out that an “orthotics case fee” was included this time as well even if not noted. Shortly thereafter I got a cheque. Ten months later after diligent and escalated follow-up, but I got it.
Can you relate? Maybe you have your own tales to relay, good as well as bad. Let me know. The University is in the process of reviewing insurers for employee benefits, so input from you on the current one could be useful.
Ramneek Pooni can be reached at firstname.lastname@example.org.