ComplaintsforGreen Shield Canada

• Initial Complaint

  08/08/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  In March my dentist tried to email greenshield the information about an upcoming appt that was scheduled for July 23. I live in a remote community so I need greenshield to approve dental travel, and then my benefits department arranges my flights etc No update by July 10th, so I checked the email and saw that the dentist misspelled theGS email address. I forwarded the email to ********************************************************* and I asked that they let me know when they receive my email.No response by July 16th, so I called GS. The person I spoke to was very kind, but could not verify if GS had received my email. they confirmed the address was correct and that it should be processed soon. They advised me to call back tomorrow.I called back the next day and the person I spoke to was also kind. They contacted the claims department and was concerned when the department told them they had processed all the claims for that period and there was still no sign of my claim. They asked me to forward the email again, to the same address, but to also include the address ***************************************************************** I sent the email and they confirmed that they received it, and then they marked it as urgent and sent it to the dental travel department. They advised me to call back to check on the status.I called back July 18th. This person wouldnt look into any information for me, told me that they would process it in the order they received it, and acted like I was wasting her time. I called again that afternoon, but the new person also acted like I was wasting his time. I tried to tell him that there kept being issues and that my claim might not be processed in time for my benefits to buy me plane tickets, and I told him that I had forwarded the email on July and he said that was only 3 business days (it was 5 business days). I was so upset that I got off the phone before remembering I had been told to call back if there was no update.Its Aug 8th and I cannot afford a flight home. Still no update.

  

  Business response

  28/08/2024

  It is my understanding that this has been resolved.  As we are a third party administrator for this benefit plan, our role is to facilitate and provide support but we do not have the authority to make final decision.  The plan sponsor of this plan has notified us this is resolved.  If this is not the case, please contact us at ******************************************************************. 
  Thank you.  

• Initial Complaint

  04/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  ID Number: ************ Issue Date: 2024/06/03 Form Number: ********** My doctor faxed my prescription to a compounding pharmacy. The pharmacist at the compounding pharmacy instructed me to mail in the prescription form along with a filled out Green Shield form which I did. My claim was rejected and I was not aware that compounded medications were not allowed. I would have never accepted the prescription had I known it would not be covered. The medication cost $101.29 and is way above my budget. I didn't expect the entire $101.29 to be covered by Green Shield, however not covering even a portion of it is extremely unfair. I have attached the original Claim Statement.Thank you

  

  Business response

  07/06/2024

  Good Morning,

  Upon review of your complaint, I can confirm your benefit plan does not allow compounded medication. I regret my response could not be more favourable as we administer these benefits based on your plan design with your plan sponsor and we do not have the autonomy to deviate from this plan design.

  Customer response

  11/06/2024

   
  Complaint: 21803653
  
  I am rejecting this response because:
  
  I believe I deserve a one time exception since it was not made clear in my plan that prescriptions from compounding pharmacies are not eligible. It is still a prescription medication and should still be partially covered at least. I do not see any logic behind denying my claim.

  Sincerely,
  
  ***************************

  

  Business response

  12/06/2024

  Good Morning *****,

  As we are obligated to follow the rules set out in your plan we cannot reimburse this claim on exception as this compound does not meet the criteria of our current compound policy. I have included your benefit booklet for reference. 

  Page 6 states:  Eligible benefits do not include and no amount will be paid for:  (h)  Mixtures, compounded by a pharmacist, that do not conform to GSC's current Compound Policy.

  I apologize my response could not be more favourable.

• Initial Complaint

  08/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Green Shield took money out of my bank without my authority

  

  Business response

  10/05/2024

  Thank you Mr. ************ We are unclear on what has transpired and require your GreenShield ID number to look up your account.  Was the money taken from your account for premiums related to your purchase of coverage?  Something different?  Can you please email further detail to our Complaints Officer so we can look into this further?  Additional information can be sent to ******************************************************************

  Thank you.

   

  Customer response

  10/05/2024

   
  Complaint: 21683223
  
  I am rejecting this response because:
  
  Sincerely,
  
  *********************

  Customer response

  12/05/2024

  When the company took out my money on May 1st I did not have any id or policy number, I did call them on that day and was informed that I did have an ID number but it was cancelled before any premiums were to be taken out of my bank. I was then informed that the system had a glitch and that it should never had taken the money out ok I get that, but how did it happen again on May 8th if they require my id number here it is : *********** they can also replay the tapes of the conversation I had on both days that I called.

  

  Business response

  29/05/2024

  Weve corresponded directly with this member since he emailed us directly with his ID number.
  Yes, his premium was taken from his account in error.  We have reimbursed him for the premium as well as 2 NSF charges to ensure he was made financially whole.
  From our perspective, this matter is closed and the member has been reimbursed all fees for which he was out of pocket.
  

  
  

  Customer response

  29/05/2024

   
  Complaint: 21683223
  
  I am rejecting this response because:
  
  Sincerely,
  
  *********************

• Initial Complaint

  30/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Hello,I tried to claim the expense of my glasses from Green Shield Canada on April 9th 2024. I was told that "There are issues with this ****** Service Provider that are preventing us from considering reimbursement for this claim. The Provider has been informed of the situation. Please contact the Provider directly for details." as in the attached statement. I tried to contact green shield but was given no help. I then contacted the supplier but I can't get a refund with a custom made prescription glasses (the picture of the glasses was also attached) which is understandable. I am filing this complaint for three reasons:1. I submitted two claims on the same day. One is for contact lens with the cost of $90, the other one is for prescription glasses with the cost of $620. Green shield reimbursed the $90 claim but denied the $620 claim even though they are from the same supplier. This gives me a feeling that they denied my claim not because of the supplier, but because of the amount they are not willing to pay out of their pocket. 2. I have been buying glasses from the same eye wear supplier for almost ten years. I never got a problem getting reimbursed before with all the other insurance companies (i.e. Canada ***** *********** etc). Starting from this year, my employer decided to switch to green shield, then everything became ridiculous. I asked the eye wear supplier, and they told me GSC is the only insurance company who denied them, and they are still arguing with GSC for the past couple of months. My friend also told me GSC refused to reimburse some prescription medicine bills because my friend didn't buy medicines from the "approved" pharmacy stores. 3. I understand if GSC is investigating or auditing some claims from other clients. But during this process, GSC should still let other customers claim. Or the least they can do is to send us a list of stores they don't like/approve, so we won't waste time or money.

  

  Business response

  28/05/2024

  Hi Ting. ****,

  We have reviewed your request and claim file.

  We can see that when you submitted your contact lenses, the service provider details were not entered so the claim paid under your *********** Spending Account automatically since you had reached your maximum under your regular vision plan.  That claim was submitted by you, via our online web service. 

  You subsequently submitted a claim for glasses that included the service provider information.  We do not recognize or allow any claims from this vision provider, Luxe Eyecare.  The vision provider is aware of our position on this.  Unfortunately, it seems they did not advise you prior to your purchase and I am sorry we cannot reimburse you. 

  Had we known the provider details on your submission for contact lenses, that claim would not have been paid either.  

  I understand this is not the response you were hoping for, however, this is our position on claims from Luxe Eyecare.  

   

• Initial Complaint

  30/01/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I had a vacation trip with my family outside Canada last December. Unfortunately my son got sick, he had a lot of ear pain and I had to take him to an emergency doctor.I'm just disgusted with the greenshield treatment. Horrible because in the last 20 days I spent more than 15 hours on the phone and nothing was resolved, one transfers the call to the other and each transfer takes an average of 60 minutes waiting and nothing and I end up hanging up because I have to work.The value is not much, probably around $150, but the lack of respect is huge.My daughter had pneumonia over 2 years ago on a family vacation and everything was resolved quickly but not now everything is complicated. Should I leave my son in agony with an earache? because if I pay for insurance, at least I expected the insurance to cover emergencies and I don't know why Greenshield is doing this.

  

  Business response

  30/01/2024

  Hi Valter, 

  Thank you for bringing this to our attention.  I am so sorry to hear this has been such a frustrating experience for you.  

  We will look into your claim right away and get back to you on status and next steps required to get this resolved.

  Thanks.

   

  Customer response

  06/02/2024

  
  I'm still waiting, no one has contacted me yet, I received this message here on BBB but I'm waiting. 
  

  Customer response

  06/02/2024

   
  Complaint: 21220677
  
  I am rejecting this response because:

  I'm still waiting, no one has contacted me yet, I received this message here on BBB but I'm waiting. 

  
  
  Sincerely,
  
  ***************************

  

  Business response

  26/02/2024

  We investigated this situation with ********** partner, who provided a very different summary of events and communications.  

  The claim was paid to the member on February 2, **** for $120.54.  

  While we have the breakdown of communication history between the member and CanAssistance, ********** partner, it likely does not make sense to dispute as the claim has been paid, reimbursed to the member. 

  Customer response

  26/02/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  22/08/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  During pandemic, the sports medicine clinic had administrator working to give files to greeshield auditor. Only one person to do this job which normally would be multiple people. Admin just asked for a couple of weeks to sort things out since a pandemic going on and had no one refused, even though she tried to reason with them. She was directed between different managers/supervisors. I can't get treatment I need because now I have to budget for it. I need more treatment of chiropractic and physio which was electronically deducted before I would not m Greenshield had said clinic would be penalized for a year, when year was up, they lied, that was last September it was to finish penalization. Spoke to my union executive board member and co wokers, they have services electronically deducted so they don't need to pay upfront. Contacted ******************* worker and explained everything. She said many others in commission are having same problem with people getting meds, reimbursements, and services. Greenshield is the worst insurance company I have seen in my 23 years in the commission. All I want is for it to go back to being electronically deducted instead of being paid up front . They only accept credit card, debit, doesn't accept cash payments with receipts.

  

  Business response

  25/09/2023

  Good Afternoon,

  The location in which the plan member is frequeting for treatment/services does not have a direct billing relationship with GreenShield.  Without this relationship, the plan member is required to pay for treatment/services and is reimbursed accordingly.

  I apologize my response could not be more favourable.

  Customer response

  04/10/2023

   
  Complaint: 20507929
  
  I am rejecting this response because:I have spoken with sports medicine rehabilitation clinic about green shields response about clinic not having a direct billing relationship with greenshield. Clinic was penalized for a year during pandemic because they asked for a couple of weeks to submit records for audit because of shortage of help during pandemic. Green shield refused. There was nothing "nefarious" going on, just shortage of staff during this time just like everywhere else across the world. The clinic tried to start direct billing again but we're refused a second time. I do not have funds to go for treatment out of pocket. I did nothing wrong, neither did clinic. I have reported it to my union rep at TTC. Do I have to find another clinic? Will I have to pay to transfer medical documents to new clinic? If this is not resolved I will be pursuing it further. Clinic may follow also.

  
  
  ***************************************************

  

  Business response

  12/10/2023

  Good Morning,

  Our position remains the same with respect to this complaint.  The issues stated in the complaint are a reflection of the relationship between this clinic and GreenShield.  We cannot make an exception to this.  As previously stated, without a direct billing relationship with GreenShield, the plan member is required to pay for treatment/services and provide documentation (ie. credit card slip, debit card slip) in order to be reimbursed accordingly.

  I again apologize my response could not be more favourable.

• Initial Complaint

  31/05/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  New customer with greenshield as of March 1st. Health insurance includes travel and medical assistance. On the benefit card is a number to call if you experience a medical issue while traveling. On March 31st I had an issue and needed medical assistance and their benefit package dates you need to contact them within 48 hours to open a claim so while the issue was occurring at the doctor's office several attempts were made by The resort the doctor and myself to call that number which does not work from Dominican. The next day I sent all the paperwork and made a claim to Greenfield which would have been April 1st and also emailed them as well telling them what was going on the day before and asking them to open a claim because their phone number didn't work. I did not get a response from them for 6 days after I was home at which point they told me to reclaim my paperwork again to a company called Allianz. When I asked her this company was they said that they handled the travel portion of the insurance for which I told them that is not stated anywhere on my brochure that that part is contracted out but anyhow, I refiled to that company. This Thursday will now be eight weeks and I still do not have my claim reviewed or paid back to me. On calls with Greenfield they don't help me and just keep saying call the other company even though I pay greenshield and not the other company. The other company, Allianz just keeps saying 6 weeks and it's in the queue and the last discussion they said 6 to 8 weeks and it's in the queue and now it's 8 weeks and I still do not have my refund for the claim and now we received an email from greenshield stating they are switching travel insurance to a different company so I don't know what's going on.

  Customer response

  19/06/2023

  Please note the company has finally paid me for the claim and you do not have to investigate further.

• Initial Complaint

  14/04/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I would bring to your attention this refusal to buy from GSC. For the claim of ***** Banville Wife As you can see from their note what is known is ***** is a Diabetic Full Blown for more than 50 years She is in her 85 year and has very bad legs GSC knows that they brovide some of her medication The toe nails was cut by a required nurse in a proper room set up for such people I am not worried about the $50. But the refusal to pay is dishonest and should be stopped.

  Customer response

  02/05/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  **** ****

• Initial Complaint

  15/12/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  Date of transaction 12/12/22 The amount I payed to the Business was a total of 1699.40 The dispute is that I was given a quote by green shield for dental work which the dentist had sent in electronically prior to the procedure being done and because the work could not be completed that same day due to the patient discomfort and had to be rescheduled I was charged a different price then I was the quote was 663.20 and I ended up paying 1069.60. They say this is due to the fact that we had reached the maximum coverage in that year. and it states that on the quote they gave us. If I was aware of this at any point in time I would have waited a few more weeks and had the remaining work completed when the benefits were at its max again. the business has explained their reasoning as to why but I do not feel this quote and what I was suppose to pay is justified. The account is ************

  

  Business response

  03/02/2023

  Hi Mr. ******,

  Our estinate response includes the information you've noted you were unaware of.  The esimate response was issued to you November 23, 2022 which was prior to both of your extraction visits on December 5 and 12.  

  The Notes section on your estimate response shows:

  *** ********* ******* ****** ** ******* ** *** ****** ****** ********** *** *** ** ******* ******* ** ** *** **** ****** ******* *** *********** ** ** ********** ****** *** ********* ****** *** ***** *** **** ********* ** ********** ** ** ***** *** ******** ***** ***** ** **** ********** ** ** ** * ***** ** ********* ** *** **** *** **** *** ********* ***** **** ***** ******** ** **** ********* **** ****** ****** ******* *** *** ****** *** *** **** ** *** ******** **** ** *** **** *** ******** *** ********** ****** ******** ****** ******* ***** ******** *****  **** ****** **** **********  ******

  It is true that had you waited for some of the extractions until January, your maximum would have been reset and you would have received more reimbursement.  However, your note that this is due to you because you were unaware of your maximum, cannot be supported as your maximum information was included on the estimate response issued November 23, 2022.  

   

  Customer response

  03/02/2023

  
  Complaint: ********
  
  I am rejecting this response because: If I have know at any time that I had exceeded the maximum amount I would have chosen to have the remainder of the teeth extracted in Jan. The estimate that was given to me was $ 663.20. Just because of a small blurb at the bottom of the form which is not clear and should not be for the patient to determine is a reflection of what happened. These factors should already be in play when presenting the amount the patient is subject to pay up front . The same amount of extractions took place as was submitting the first time by the dentist therefore it is up to the insurance company to reflect the actual amount to have that procedure done and not change after the work has been completed.
  
  Sincerely,
  
  ****** ******

   

  

  Business response

  09/02/2023

  The annual maximum was stated on the estimate that was provided to the plan member.  However, we understand the plan member would have booked the 2nd appointment for extractions in January when the full annual maximum renewed.  In good faith we have reprocessed the claims and reimbursed the plan member accordingly and the amount reimbursed will be deducted from her 2023 maximum.

  Customer response

  09/02/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ****** ******

• Initial Complaint

  21/11/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  I have coverage for mental health services by an MSW with green shield via my employer. I selected a provider based on her credentials and certification as a social worker, to ensure it would be covered by my plan. When I submitted the claim as a social worker service, it was denied. I was told that Green Shield needed to verify the providers credentials as an MSW and that I needed to resubmit the claim as an MSW service not a social work service. I have been trying unsuccessfully for over one month to ensure that if I submitted the claim again, green shield would contact the provider to verify her credentials. They seem to want me, a patient, to contact my provider and ask for a copy of her diploma, which is incredibly inappropriate. I also do not see anywhere in my booklet that I should be required to do this. To date, I have no evidence that green shield is reaching out to the provider to ask for a copy of her credentials. They are making it impossible for me to access my own benefits by this administrative red tape, and they are refusing to do the basic bare minimum to validate my very valid claim. To me, this amounts to fraud as I’m not able to get reimbursement for a claim that I am eligible and pay for. I am unable to seek resolution with green shield directly as they’ve refused to answer my direct questions over a series of emails and copy and paste the same message over and over again, and my claims are automatically denied once resubmitted. The amount has been sitting on my credit card, now collecting interest, for over a month and I have not been able to continue my counselling due to the uncertainty of this reimbursement and the cost associated with carrying the unanticipated fees.

  

  Business response

  01/12/2022

  Good Afternoon,

  As the plan member's benefit plan covers services performed by a Master of Social Worker (MSW) we require a copy of the provider's diploma initially to verify their credentials.  We have contacted the provider and obtained their diploma.  We have loaded this provider in our registry and will not ask of such again.  One of our supervisor's have contacted the plan member to notify them as such and the claims have been reprocessed and reimbursement will be made in the next two business days.  

  Kindest Regards

  ******* ****

  Customer response

  12/12/2022

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID 18444462, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *** *******

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