Premature twins suffering from necrotizing enterocolitis face insurance carrier flip flop leaving advisor’s client with potentially devastating financial responsibility.
No advisor ever wants a confrontation with one of their insurance carriers over a rejected claim but it’s especially important that it doesn’t result in financial hardship for the client.
The recent case of Ontario twins Shaylyn and Grayson Grant, who’ve suffered from various health issues since the day they were born six weeks premature, illustrates why advisors need to continually be in contact with their clients.
It’s all part of knowing your client.
In this particular situation the family were told by a Sun Life employee that Neocate, the specialized formula they required for their nutritional well-being, and costs $2,400 per month, was covered under their extended medical plan.
But when the family next contacted the insurance carrier they were told that this wasn’t in fact true and that because it was considered formula rather than a drug, it also wasn’t covered under OHIP.
“We called the insurance company. They indicated it was covered 100 percent up to 20 thousand dollars per year per child,” said Jamie Barrette, the twins’ mother.
Interestingly, Sun Life has admitted to the couple that they made a mistake but have yet to comment on the details of this claim.
LHP reached out to Chilliwack-based certified health insurance specialist Ken MacCoy for his thoughts on the flip flop.
“The employee of Sun Life created an Estoppel. I say take Sun Life to court and sue them,” says MacCoy. “Should OHIP cover if the insurance company doesn’t ...YES, of course they should. But, OHIP could cover the formula and subrogate against Sun Life based on the principle of Estoppel.”
Advisors pay attention to this very unique case.
Customer service most certainly includes knowing your client and what’s happening in their lives. To do anything less is to abdicate your responsibility as an advisor.
The recent case of Ontario twins Shaylyn and Grayson Grant, who’ve suffered from various health issues since the day they were born six weeks premature, illustrates why advisors need to continually be in contact with their clients.
It’s all part of knowing your client.
In this particular situation the family were told by a Sun Life employee that Neocate, the specialized formula they required for their nutritional well-being, and costs $2,400 per month, was covered under their extended medical plan.
But when the family next contacted the insurance carrier they were told that this wasn’t in fact true and that because it was considered formula rather than a drug, it also wasn’t covered under OHIP.
“We called the insurance company. They indicated it was covered 100 percent up to 20 thousand dollars per year per child,” said Jamie Barrette, the twins’ mother.
Interestingly, Sun Life has admitted to the couple that they made a mistake but have yet to comment on the details of this claim.
LHP reached out to Chilliwack-based certified health insurance specialist Ken MacCoy for his thoughts on the flip flop.
“The employee of Sun Life created an Estoppel. I say take Sun Life to court and sue them,” says MacCoy. “Should OHIP cover if the insurance company doesn’t ...YES, of course they should. But, OHIP could cover the formula and subrogate against Sun Life based on the principle of Estoppel.”
Advisors pay attention to this very unique case.
Customer service most certainly includes knowing your client and what’s happening in their lives. To do anything less is to abdicate your responsibility as an advisor.
