Health Benefits Issue - Grrr

I have been working for this company for over 7 years now. I have over $100 deducted from my pay bi-weekly for my benefits. I have the "single" coverage plan. I have always had that from day one. My husband has the "family" plan with his company. I have only ever used his benefits once in my life for eyeglasses as our company does not offer any benefits towards glasses. The only times I have used my benefits is for my dental checkups and cleaning 3 to 4 times a year. THAT'S IT. I do not take medication or go to chiropractors, massages....NOTHING. While our company benefits cover 80% of the cost for cleaning, the 20% comes out of my pocket, HOWEVER, I can claim that 20% through the insurance company (they offer some type of account that we can go into to get reimbursed and the maximum is $300 a year). Well I went to the dentist a month ago and submitted the receipt for the 20% that I had to pay. It was $34. I have been checking my bank account daily for the last 2 weeks and there has been no deposit from the insurance company. I finally called them today and asked them why they haven't reimbursed me the $34 and they told me I was "declined". I asked them why and they told me that I have to go through my husband's insurance. I completely lost it!! I told them that I have been submitting my receipts for the last 7 years and this year alone, I had already submitted 2 previous receipts and they were all processed and paid. What on earth changed in the last month? Basically they told me I have to exhaust all my other options before I put a claim in through them. WTF???? Then why am I paying for benefits?? I am shaking right now.

Sorry everyone, I had to vent.

welcome to the world of " the run around " in the insurance company game. I could tell many of my own tales, but I'll spare you. Just do exactly what they say, making photo copies of every claim for your own protection until you get the money back for each one. Document everything, even write down the date you mail each thing off.
Read the fine print on the " explanations " area as to why and how much of a claim was allowed, or if it was declined. It can be exhausting, I do know that. Plus when you are dealing with a family of 5 it can get rather complicated on the co pays.
I do not know if you have kids, but if so, most insurance companies insist the kids appointment charges go through the parent ( member's plan ) who has the EARLIEST birthday. Then the remaining charges are picked up on the other parent's co pay plan. I have no idea why?? lol
Good luck.

I work in a dental office and that is all we get is the roll run around - Sunlife and Manulife are the worst followed by Great West Life - the best Green Shield. When a person is double covered like you - it MUST go through yours first as primary holder, then what ever is life must go through his - if you have a health savings account or something like that it goes before it goes to his.
I use to work at a call center for an insurance company long ago :)

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Originally Posted by anastasia1009

I work in a dental office and that is all we get is the roll run around - Sunlife and Manulife are the worst followed by Great West Life - the best Green Shield. When a person is double covered like you - it MUST go through yours first as primary holder, then what ever is life must go through his - if you have a health savings account or something like that it goes before it goes to his.
I use to work at a call center for an insurance company long ago :)

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lol. Our dental insurance company is great west life and medical insurance company is sunlife. God bless us. Lol


by the way we never had any problems with both these companies yet. Maybe it's because my husband is the only bread winner in our house. I am stay at home QUEEN. Lol.

@walkonby - No, I do not have any children. I have 3 stepdaughters and 3 grandchildren. It is just my husband and I (3 stepdaughters are all married). I just don't understand how I have been able to claim for 7 years and now it's an issue. The only reason my husband added me to his benefits years ago was so I could claim for eyeglasses, other than that, I have never used his benefit plan only mine. I will call again tomorrow and ask to speak to a manager and we'll see what happens.

The group benefits coverage from your employer should absolutely be first payor. Then, under coordination of benefits, your husband's coverage should pay the outstanding balance. This assumes, of course, that neither of you has exceeded any limits on your dental coverage during this benefit year and that the procedures are fully covered. (eg. certain types of fillings are not -- if you want porcelain some insurers will pay the basic cost and you pay the rest. Some dentists also charge above the provincial fee schedule, so the overage usually becomes your responsibility.) This is Insurance 101 and it is such standard practice that it is included in insurance licensing study materials and on insurance license exams. In fact, you are required to submit to your own insurer first, then to the insurer for whom you are a 'dependent' under your husband's coverage.

You may want to 'do the math' on the cost of your DH's benefits and yours. You are paying a lot of money every month and it could be that one of you being a dependent under the other's plan might actually save you some money. Two plans at this stage of your life may be too much coverage.

Important edit: If I understand correctly, and you are getting 3-4 cleanings and check-ups a year that is likely what is causing the problem. Most plans cover two check ups and two cleanings a year....so the first two would be paid for by your plan and the third and fourth would be through your husband's.

Important edit: If I understand correctly, and you are getting 3-4 cleanings and check-ups a year that is likely what is causing the problem. Most plans cover two check ups and two cleanings a year....so the first two would be paid for by your plan and the third and fourth would be through your husband's.

Dianne, thank you for your response. Our dental plan is based on an amount. We are covered for up to $1500 a year. I do not even come close to that in a year. Basically, I can go for 20 visits in a year provided I do not exceed $1500 (I exaggerated the amount of times I can go). I simply submit approximately $30-$40 per visit x 3 to 4 visits per year. I understand about perhaps cancelling my benefits and going just with my husband's plan but our benefits have a lot of pros to them.

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Originally Posted by toronto166

I have been working for this company for over 7 years now. I have over $100 deducted from my pay bi-weekly for my benefits. I have the "single" coverage plan. I have always had that from day one. My husband has the "family" plan with his company. I have only ever used his benefits once in my life for eyeglasses as our company does not offer any benefits towards glasses. The only times I have used my benefits is for my dental checkups and cleaning 3 to 4 times a year. THAT'S IT. I do not take medication or go to chiropractors, massages....NOTHING. While our company benefits cover 80% of the cost for cleaning, the 20% comes out of my pocket, HOWEVER, I can claim that 20% through the insurance company (they offer some type of account that we can go into to get reimbursed and the maximum is $300 a year). Well I went to the dentist a month ago and submitted the receipt for the 20% that I had to pay. It was $34. I have been checking my bank account daily for the last 2 weeks and there has been no deposit from the insurance company. I finally called them today and asked them why they haven't reimbursed me the $34 and they told me I was "declined". I asked them why and they told me that I have to go through my husband's insurance. I completely lost it!! I told them that I have been submitting my receipts for the last 7 years and this year alone, I had already submitted 2 previous receipts and they were all processed and paid. What on earth changed in the last month? Basically they told me I have to exhaust all my other options before I put a claim in through them. WTF???? Then why am I paying for benefits?? I am shaking right now.

Sorry everyone, I had to vent.

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Why are you paying $2600/year for this? It doesn't seem like you're using that much in 'benefits'. And you're covered on your husbands plan.

You have spent almost $18,200 in 7 years!!! This is one of the most expensive plans I have ever heard about..you say you only go for cleanings and have never used it for anything else..I would cancel yours and go with your husbands, you said he already pays for the family plan..if you have to pay something out of pocket you'll still be way ahead!! Most plans you can cancel, try your husbands and if for some reason it doesn't work for you then you can go back on the plan...

UPDATE*** - Lo and behold, I looked at my bank account this morning and my money was in there.

Thank you to everyone for all your help.

[QUOTE=toronto166;6029262]UPDATE*** - Lo and behold, I looked at my bank account this morning and my money was in there.

Thank you to everyone for all your help.[/QUOTE}

Glad that everything is resolved!

I didn't think people were allowed to be "single" on a plan if married. When my husband and I got married, we had to choose his plan or mine, as we would have ended up both having to pay for "family" coverage at work, which would have been really expensive!

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Originally Posted by Minou

I didn't think people were allowed to be "single" on a plan if married. When my husband and I got married, we had to choose his plan or mine, as we would have ended up both having to pay for "family" coverage at work, which would have been really expensive!

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I am single on my plan and my husband's plan covers both of us. I only selected very basic benefits for mine whereas for his he selected everything. We have no prescriptions to speak of and use very little extended health. He has good coverage for EHB and dental. I've done the math many times and it doesn't make sense for me to carry much coverage at all on my plan. We re-enroll annually where I work so I have the option to choose full coverage if need be on April 1st of any year.

Wow. I am blown away by the amount that you are paying for your benefits.

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Originally Posted by toronto166

UPDATE*** - Lo and behold, I looked at my bank account this morning and my money was in there.

Thank you to everyone for all your help.

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Glad to hear it got resolved