Post
by MichaelWalker » Tue Jul 14, 2009 4:44 pm
Thank you all for the excellent feedback on this problem.
I thought I'd update this thread with the latest:
I ended up calling the union first to see what they'd have to say. Unfortunately, they were of no help as they would only arbitrate if it was a "systemic" problem (however they define that - I didn't ask). Since I was the first to bring this issue to their attention, they'd only keep a reference and contact me if further complaints arose. No help there.
I put my focus back to the insurance company. The first three calls were nearly identical: they'd only cover the 80% on equipment sourced in my province, not Canada wide or from the US. On the fourth attempt, however, I asked for the actual policy documents that spelled this limitation out. The rep said they couldn't provide that data because it would be multi-volume books in length. I asked for more than the vague summary available on their web site and was told a more detailed document wasn't available in any form. Asking to get bumped up the chain a few times, miraculously I was told that indeed, I could source the equipment Canada wide not just in my province. After being told the opposite five times previously (and specifically asked and verified each time), the rep only replied that this was "new" information he just found in my policy (of which, I can't get a copy).
Fully convinced now that these people were "making it up" as we went along, I asked for ANY documentation from this rep that was in any way specific. Again, miraculously, I was now told that my policy had a "US" clause in it and, pending approval of the specific equipment brand and type, I could source it from the US.
I immediately took his name and the time of call, asked him to make a note in the system of exactly what he just said, thanked him and politely hung up. I then went and ordered the IntelliPAP with humidifier and software, ResMed Swift LT and replacement filters from cpap.com. (Unfortunately someone from cpap.com called the next day and said they couldn't ship any ResMed products to Canada, but that's a whole different issue).
So. Moral of the story: If anyone on these boards from Canada ever has to deal with Pacific Blue Cross -- DON'T GIVE UP when they say "no". It seems the more persistent you are with this company the more your policy dynamically changes in your favor.
Again, thank you all for your ideas and help walking this path . I still haven't submitted my invoices to PBC as my equipment just arrived, but I'm almost positive I'll have it covered now for less than a third of the cost it would have been locally (for identical equipment, of course).
My best to you.
Michael