Any Canadians with Desjardins group health insurance?

Out of curiousity..

Any other Canadians who have filed claims under Desjardins Group Health insurance? They're my provider, and I'm getting VERY frustrated trying to find out just what they'll cover. They told me they'll cover $10,000/lifetime for "CPAP equipment and supplies" which includes 1 CPAP machine purchase/lifetime. Now they also are requesting all my ADP paperwork because they only want to pay the 25% co-pay. They also will absolutely not tell me the specifics of what is considered "CPAP equipment and supplies". They divulged that they will pay for 1 mask/year and 1 hose/year, but will not cover any disinfectant wipes, battery backups, humidifier chamber replacement, or anything.

Now, I'm absolutely thankful that the government has ADP in place to pick up 75% of the tab. Again, I'm thankful to have group health insurance that will cover the remaining 25%. It might sound greedy of me, but if they're willing to cover $10,000 in equipment and supplies, I don't want to be going to pocket for ANYTHING. I consider a battery backup for my CPAP an absolute necessity, and do not think I should have to pay myself for it when my plan SHOULD consider it 'CPAP equipment/supplies'.

My other thought was to pay the 25% ADP client portion myself, and get them to pay for a machine with an integrated battery backup (like the Everest2). The customer service representatives I've spoken to have told me "But, Sir. We pay 100% of your machine purchase". I respond with "If you're only paying the ADP client portion, then they're NOT covering 100% of my machine purchase.. you're paying 25%".

I'm just getting very frustrated because no one will give me any specifics. I've called three different CSRs and gotten 3 different answers, none of which help me out.

(Le sigh!)

Insurance companies are the bane of my existence right now Chris. I'm not with Desjardin so I can't help you on that front too much.

Ask to speak with a supervisor and don't let them tell you no. I've been fighting with my home insurance provider for over a month as they decided not to renew my rental properties (a bus hit one of the houses...freak accident, minimal damage considering). I've been going out of my mind as that decision has stuck us into a "high risk" catagory and the lowest quotes I have been able to get have been over $3000 as a result. I pushed to speak with a supervisor, then the manager of underwriting, and finally the obudsman to help me deal with this situation. While everyone but the underwriting manager was recommending they keep our policy at least it got pushed to highest levels. I ended up getting a really good quote today from my life insurance company (believe it or not), and switched over coverage today.

Even though I didn't win my fight, I did get a concession and if we go the year claim free, they will reinstate our coverage. (we are with a really really inexpensive group insurance company so I will go back).

Seriously, keep going with them until you get the answers you need. We are with Sun LIfe for medical and they've been great. Do you have online access to your group benefits? We looked up our coverage online as well once I got us registered. It was great as I could double check everything covered in case I wrote something down wrong.

Keep at em!!!

Chris. I asked DH if he knew anyone on that plan. It looks like you can access your plan info online. Try http://www.dsf-dfs.com/en-CA/Prtclrs/Dt ... rsttns.htm

It's worth a shot.

To register go https://www.assurancecollectivedesjardi ... /AA11.asp? Hopefully you can get some answers

Cheers

Hey guys,

My co-workers husband needs a cpap, so she's in a similar position. We're in Quebec, but she's not sure if Dejardins will cover any or all of the expenses of the machine. Is 25% the maximum they will cover?

Ryan

It will be different in Quebec. In Ontario, the insurance pays a lot less because they assume ADP (an Ontario program) is paying the bulk. You'll get a MUCH higher percentage (if not the whole thing) in another province.

Just as a general comment about outfits like Desjardins, Great West Life, Sun-Life and the other Canadian Group Insurance Companies that out there. They're coverage is dictated in the terms of the Plan by which you are covered. As an example, Great West Life is the Group Insurer for my company but in that regard they simply administer the plan, coverage rules are set by my employer from a huge "menu" of possible coverages and different rules/coverages are in place for unionized staff, managers, and senior executives. Disputes with GWL are referred back to an in-house benefits manager.

I bring this up because I regularly see people here questioning/crticizing one insurer versus another and presuming that their coverage rules can be determined by the experiences of others on this forum. If you don't know your rights under the plan, contact the insurer and if dissatisfied, escalate the issue to your benefits people. In many cases, current coverages have been negotiated by your union who may also be a source of assistance if it seems nobody else will give you a break.