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Sun Life Financial / Partial claim rejection

1 Ontario, Canada

For over a year I have had a recurring problem with claims for low cost prescription drugs. I am covered by the Ontario Drug Benefit plan for seniors so my cost for most prescriptions is $4.11. For some never explained reason when I submit a claim for a lost cost drug the claim is covered "only up to the reasonable and customary amount" (see example attached).

When I first realized what was happening was illogical, I contacted Sun Life by phone and got nowhere. So in March 2012 I started a long string of messages to Sun Life. I received an apology for the error and a correction followed. I pointed out that this must be a flaw in their process that impacts many clients. In one phone conversation I was told that it must only be affecting me since there are no complaints from other clients. This is likely because the amount of the error is small and no one else notices or bothers to challenge. I too would ignore a one off occurrence, but it has happened many times in the last year and each occurrence resulting in the hassle of messages and a correcting entry.

The amount is small so it really doesn't mean much at an individual level. Collectively though Sun Life is wrongly saving an expense that likely adds up to a nice total.

Sun Life Financial
Sun Life Financial

May 31, 2013

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