Prescription pain medication, classified as “narcotic analgesics,” are covered under drug formularies. Some plan sponsors will be surprised to learn that narcotic medications can be a significant part of their drug spend. When Beneplan looks at drug usage reports for our benefits co-operative, we sometimes see narcotics at an unusually high amount. This could be […]
We had a chance to see Dr Richard Celko DMD speak at the Canadian Health Care Anti-fraud Association Conference on Sept 21st, 2012 on how he determines if a dental claim is fraudulent. Here are some of the higher-level insights from the seminar. Dr Celko estimates that 15% to 20% of dentists are either fraudulent or […]
Our paramedical claims manager had a very enlightening discussion with a chiropractor about a insurance fraud scams around compression hose. Compression Hose Fraud is Widespread in Benefit Plans Drug stores are “working out a deal” with some customers who have insurance coverage regarding the compression hose. The member is informed to get a prescription from […]
Beneplan recently interviewed Shawn Friedenberger, Communications Advisor at the Worker’s Compensation Board in Alberta (WCB Alberta). We’re interested to know how the WCB benefits interact with private health services plan benefits. For example, if someone gets injured on the job, then requires physiotherapy, and his employer’s plan has this benefit in place, who pays for the […]
Many Canadian health benefit plans have coverage for orthotics or orthopaedic shoes. The plans we place through The Co-operators usually cover $300 or $500 for either custom orthotic inserts or custom orthopaedic shoes, which must be dispensed by a foot specialist such as a podiatrist or chiropodist. If you don’t have a benefit plan, or […]
How to Negotiate with your Dentist It is possible to negotiate with your dentist for lower rates, since the markup that dentists charge on procedures can vary from office to office. Some charge above the “fair market price” which can be found in the current year’s Dental Fee Guide. The Dental fee guide is an […]
Most of the new cancer drugs which Health Canada are approving for use in 2011 and 2012 are oral, versus in a vial – meaning that instead of chemotherapy treatments being strictly administered intravenously by a doctor, patients can now be given a prescription to pick up their oral cancer medication at their local pharmacy. One […]
In the fall of 2009, CBC reported that Nathalie Blanchard, who was on long term disability (LTD) for depression, had her benefits cut off by Manulife after they found pictures of her on Facebook having fun on the beach and in a bar with friends. She claimed that she was trying to have fun on […]
The Ontario government has a drug plan called the Ontario Trillium Drug Program (“Trillium”). This is available to Ontarians who either: do not have drug coverage; or, who have reached the maximum on their drug coverage; or, their drug deductibles are very large compared to their household income. Trillium steps in and help […]
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