Federal public service employees and retirees are having difficulty getting reimbursed for medical expenses incurred abroad because they were insured with Canada Life. Radio-Canada has learned that the problems are so severe that the government has loaned workers $1.8 million.
Pensioner Roseline Roy has very difficult memories of her hiking trip to Greece last October.
On the third day, my foot slipped on a rock and I suffered a double ankle fracture, says the sexagenarian I met at her home in Gatineau. In the middle of the forest, Ms. Roy had to be evacuated by firefighters who carried her on a stretcher to a beach accessible only by boat. The next day she had surgery.
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Photo taken during the emergency transport of Roseline Roy
Photo: Courtesy of Roseline Roy
Roseline Roy's stress levels are at their peak. Neither she nor her daughters or their friends have been able to contact MSH International, Canada Life's subcontractor responsible for emergency travel assistance and administration of the company's health plan (RSSFP) abroad.
Just a few days after the operation, Roseline Roy managed to speak to an MSH International employee. That's reassuring.
She confirms that the operation will be paid for and that Ms. Roy will be able to return to the country in business class so that her leg will be in an elevated position during the trip – a condition the doctor sets for her to be on the plane.
She had to contact the hospital to collect the bill. [mais] This did not happen, says Ms. Roy. Along with the plane ticket and other related costs, the pensioner had to pay almost $30,000, an amount that was paid with her credit card and then transferred to her line of credit.
On October 27, Roseline Roy submitted her claim online to MSH International. And no news since then.
I didn't even call back [pour essayer de faire un suivi]“I don't have the courage to face it again, I'll wait,” explains Ms. Roy, who is not yet fully able to walk again after her accident.
I'm paying for a service that I don't get and I think it's completely unfair that I have to pay for it [des] Interests [là-dessus].
After seeing numerous testimonies on social media from officials unable to reach MSH International, she prefers to save her energy to go to her medical appointments.
“I find that a bit absurd,” says the pensioner, who doesn’t know who to contact to get a refund. I tell myself that if it were a contract that I made myself, I think I would have recourse […]“But there, this contract, I didn’t sign it, so I feel a bit like a victim of a system,” she complains.
A daily problem
Federal government employees residing outside Canada also complain about the poor quality of service provided by MSH International, which they must work with to reimburse ongoing medical costs.
Since Canada Life took over the insurance service in July, I probably tried to get in touch [MSH International] 20 or more phone calls, says officer Sonia Hooykaas, who lives in London with her six-year-old autistic daughter.
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Sonia Hooykaas' daughter and her assistance dog.
Photo: Courtesy of Sonia Hooykaas
Both have had to undergo an operation in recent months, which must be approved in advance by the insurer. “I probably spent 40 hours, if not more, waiting and listening to her terrible piano music over and over again,” exclaims Sonia Hooykaas.
It was panic, stress, […] it is exhausting. It's tiring to call and listen to the phones, no one can answer your questions.
As a single mother raising her child abroad, Sonia Hooykaas says she is frightened by the thought of spending $13,500 without the slightest idea of what will be covered and how long it will take to get a refund .
Ms. Hooykaas says she has filed 17 claims against MSH International totaling about $45,000. Five claims were reportedly processed, two of which were not paid properly due to an exchange rate issue. The officer is still waiting for a refund of just over $41,000.
When the government grants loans
Like other Global Affairs Canada (GAC) employees, Sonia Hooykaas has no choice but to ask her employer for a loan to pay her bills while she waits for reimbursement.
“This morning I'm busily filling out all the loan paperwork again, hoping to get another one – my third since mid-August – to cover the costs,” she explains, illustrating the ridiculousness of the situation.
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Sonia Hooykaas and her daughter
Photo: Courtesy of Sonia Hooykaas
Since switching insurers, AMC has advanced $1.8 million to employees to cover medical or dental costs, says Pierre Cuguen, AMC spokesman. So far, only $300,000 has been refunded, he said in an email.
“Over the last four years, an average of 9 to 12 advances have been granted each month to help employees access health services abroad,” notes Mr. Cuguen. However, since July 2023, averages have increased to 23 advances per month.
AMC employees abroad can count on an interest-free advance for medical expenses, as they usually have to cover these costs themselves and are then reimbursed by the insurer.
Sonia Hooykaas considers herself lucky to be able to count on this financial support, but believes that her employer still needs to ensure that the plan is managed appropriately.
Professional Association of Foreign Service Officers President Pamela Isfeld worries the problems with Canada Life and MSH International will cause people to postpone medical care.
I am very worried. […] I think it's unfair, it's dangerous.
Isfeld says her union has received about 100 complaints, but that's likely just the tip of the iceberg. She wants the government to clarify this matter as a matter of priority and, if necessary, consider other solutions, such as temporarily using the services of another insurer.
Switch to another insurer
U.S.-based civil servant Elizabeth Weissman has also racked up several unreimbursed claims from MSH International since July. She estimates the company owes her about $2,000. I put this on my credit card, it comes out of my pocket, she lets it go.
They are being paid for a service they do not provide, it is shameful.
Between her unanswered emails, her attempts to follow up by phone, and her unpaid claims, Ms. Weissman begins to worry. It's really stressful, she admits.
When she retired, she decided to take extreme measures and take out private insurance, which cost her more than $1,000 a month.
I do not trust [en MSH International] And if something catastrophic happens, an accident, an emergency operation, I can't pay $30,000, she analyzes.
Company processes
A few hours after Radio-Canada contacted MSH International, the company contacted everyone who testified in this article. A spokesperson for Canada Life confirms that MSH International is currently investigating each case and that claims will be processed as soon as all necessary information is received.
No sanction for Canada Life
Given the current situation, the federal government continues to hold daily meetings with Canada Life management regarding administration [régime d’assurance]explains Joie Huynh, spokesperson for the Secretariat of the Treasury Board.
Canada Life has told the government that MSH has hired more staff with security clearances and PSHCP training for the call center and claims processing, explains Joie Huynh.
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MSH International's offices are located in downtown Toronto.
Photo: Radio-Canada / Sue Godspeed
The insurer benefited from a transition period until January 1, 2024, from which date the government was scheduled to begin monitoring service level performance, according to the $514 million contract signed with Canada Life, reported by Radio Canada has received a copy.
Despite the ongoing problems faced by civil servants and pensioners, the government does not currently plan to sanction Canada Life. But financial sanctions or payment withholdings are part of the government's arsenal, confirms Stéfanie Hamel, spokeswoman for Public Services and Procurement Canada (PSPC).
In most cases where a supplier experiences delays, PSPC prioritizes working with the supplier to remedy the situation, explains Ms. Hamel. To date, Canada Life continues to make progress in implementing this approach, she adds.
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Anita Anand, President of the Treasury Board (file photo)
Photo: The Canadian Press / Justin Tang
The Treasury Board president says she shares the concerns of members suffering delays in getting their claims reimbursed.
“My team continues to pressure Canada Life to work with its subcontractor MSH to reduce wait times,” Minister Anita Anand said via email.
Canada Life on the defensive
Canada Life denies failing to meet the service levels set out in the contract signed with the federal government.
By email, the company says it responded to more than 90% of calls received last week within 40 seconds. Claims submitted online were processed within a day, she said.
Canada Life also blames the problems surrounding MSH International on the former insurer of federal officials.
When MSH started running the service [à l’extérieur du Canada], there were more than 12,000 unprocessed complaints from the previous supplier, a spokesman clarifies. MSH worked to reduce this unexpected backlog by a third while processing new claims.
MSH International did not wish to answer Radio-Canada's questions for this article.
Pamela Kwiatkowski, MSH International's chief revenue officer, said in an email that Canada Life responded [aux questions] on behalf of both organizations.