One of the biggest benefits that your workplace (hopefully) offers is medical and dental benefits.  My work offers decent benefits – my husband’s offers excellent ones.  It can be a pain to fill in paperwork, and submit a claim to one company, then have to submit a claim to another one, but it’s well worth it. Here are some tips I’ve learned that will hopefully make it easier for you to submit medical and dental claims, and ensure you get back all the money you can.

1. The easiest way to not have to pay money out on prescriptions is to see if your insurance company offers a drug card. Mine does (it’s Sunlife). I’ve provided my local pharmacy with the information on it, and when I go to get a prescription filled, they automatically ring through whatever the insurance company will pay, and I only have to pay the difference. So find out if your company has a drug card, and if they do –use it!
2. My dentist also contacts my insurance company directly – right while they’re ringing up my bill. I assume it’s all computerized, because within moments of contacting the insurance company, they get a coverage statement back.  I don’t have to do anything! I just have to pay the bill up front, and then money from the insurance company automatically gets deposited to my account a few days later.  So – bring information like your policy and ID number to your dentist and see if they offer direct submission to your insurance company.
3. See if your company offers online submission. If you’re not big on filling in paperwork, it may be possible to submit a claim online. I’ve done that a few times this year – once for naturopath visits, and once for medication obtained directly from a doctor.  The naturopath visit claim went through without a hitch, but not the medication one. I had to scan the receipts and email them, but that wasn’t too much extra work.
4. And the least fun option. Fill in your paperwork. I know, I know – it’s boring and no fun. My husband’s company makes you fill in information for each medication – even though all that information is available on the receipts.  I hate doing it, but his coverage is great, so I do. Remember – just because your company covered some of the costs doesn’t mean you shouldn’t submit the rest of the costs to your spouse or partner’s company.  They may cover the rest and may also cover things your company wouldn’t cover at all.  And before you mail it out – PHOTOCOPY  everything. You never know when something will get lost in the mail or you’ll have to resubmit a claim.

What if the company rejects my claim?

Okay, this sucks, and rumor has it that insurance companies do this outright with some big claims just to see if you’ll make the effort to fight them. If your claim is rejected or you didn’t get back as much as you expected:

1. Check your benefits coverage and your paperwork. Something you thought would be covered may not be, or you may have made a mistake in the paperwork.
2. Try to contact the insurance company via email or phone.  After my husband’s company claimed that the package I sent them twice never got there, we tracked down a phone number for his insurance company that put us in touch with a section that only dealt with my husband’s company. That was very helpful.
3. Check the claim processed information your company provided. Mine mucked up a date and I didn’t catch it before I sent everything in to my husband’s company. So, my husband’s company then screwed up their claim processing, and didn’t give us back everything we were entitled to. When I tried to explain this to them, they then claimed I owed them money back!  I then sat down, figured out exactly where all the mistakes were, and sent them a detailed letter explaining the whole thing. It was a pain, and quite stressful, but we got all the money back in the end. Phew!

How do you deal with medical and dental claims? Have you ever run into any real issues trying to get your money back?

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