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Article du mois
Article of the month

 

 

WHY WAS MY CLIENT NOT REIMBURSED BY HIS INSURANCE COMPANY?
by Jocelyn Vincent, translated by Mariette Troisfontaines

One question that is often asked: Why was my client not reimbursed by his insurance company?

Several factors influence the insurance reimbursement of the receipts.

The foremost important factor is the plan offered to the policyholder.   It is important to keep in mind that the policy that covers the employee is, firstly, a contract between the employer and the insurance company.   This contract contains clauses which covers or excludes certain treatments.   Each additional premium coverage increases the price of the policy.   For example: the employer may decide to take an insurance policy which covers reparations for dental and eye glasses, but has removed the naturopath services.   It is essential that the client verifies the contract clauses to insure themselves that the services they wish are covered.

The second most important factor is the obligation of the policyholder to procure a medical reference in order to obtain the service.     Certain insurers reimburse for alternative health treatments only with a medical prescription.

The third factor is the maximum amount allotted annually.   Most insurance companies have a limited fixed amount either by year or by appointment.   Exemple: the employer may chose an insurance contract which offers either a maximal amount of 500$/year or 20$/treatment with no maximal amount mention for alternative health treatments for his employees.   The non reimbursement is often experienced at the end of the year.   The client has always been reimbursed and all of a sudden is no longer simply because he has attained the maximal annual coverage allotted.

As you have noticed it's a matter of price.   More coverages means higher premium costs.   The employer has to evaluate the costs in function to his financial capacities and those of his employees because, usually, the employer has to disburse a certain percentage.  

It is important to note that it is the client's responsibility to verify the reason of the refusal with their insurance company.   You can understand that in order to protect the confidentiality of the files, the insurances companies are unable to disclose any information to a third party.

Jocelyn Vincent is a massage therapist and the president of the ACTMD
For information, please call (450) 659-5282
www.CentreSante.com

 

 

 

 

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