Beneva says it is removing prescription requirements in response to complaints from physician members of the Fédération des médecins omnipraticiens du Québec (FMOQ) about the amount of time they spend filling out insurance documents. According to statistics recently released by the FMOQ, the most revealing finding is that insurance paperwork takes up 24 per cent of its members' time. The FMOQ has urged insurers to ease this burden.
Beneva has heeded this call: Across Canada, it no longer requires its group insurance clients to provide medical prescriptions when they submit claims for paramedical services.
In making this announcement, the insurer took the opportunity to point out that it uses the standardized form agreed upon by the Canadian Life and Health Insurance Association (CLHIA) and the FMOQ to administer disability insurance claims.
“We are pleased to help reduce the administrative burden of family physicians so that they can devote more time to the care of their patients, who are also in many cases our plan members,” said ÉricTrudel, Executive Vice-President and Group Insurance Leader at Beneva.
No more mental health prescriptions
“It is through the sum of small, caring gestures that we help improve the fluidity of services provided by physicians," adds Éric Trudel. Thus, Beneva no longer requires a prescription for psychology, physiotherapy or chiropractic services, except for rare exceptions.
Trudel told Insurance Portal that Beneva has been phasing out the requirement for a doctor's prescription for a visit to a health care professional, for clients submitting claims for reimbursement by the group plan. "This change has been under way for a few years now. The survey recently released by the FMOQ showed us that we should continue in this direction, so we have gone one step further to ease some of the requirements that were still in place,” Beneva’s Executive Vice-President and Group Insurance Leader explains.
The elimination of prescriptions will shorten processing time, Éric Trudel continues. He points out that insureds will not have to wait to visit a doctor before being able to request reimbursement for paramedical care. “We believe that this simplifies life for everyone involved in the chain, since insured who are unhappy about having to see their doctor to be able to file a claim under their group plan may complain to the plan sponsor, who in turn will ask their consultant or broker for an explanation. Bypassing subscriptions improves the customer experience,” Trudel says.
1.7 million claims
Beneva listed psychology, physiotherapy and chiropractic services in its release because they are among the top categories of expenses for which Beneva receives group insurance claims, Trudel adds. He shared statistics with Insurance Portal on Dec. 20, indicating the number of claims by category of paramedical care submitted to Beneva in the last 12 months. He notes that these claims statistics relate to Beneva's group insurance experience in Quebec only. In descending order, they are:
- 400,000 physiotherapy This includes claims for the cost of a physiotherapist or physical rehabilitation therapist
- 400,000 chiropractic claims
- 270,000 psychology These include claims for expenses incurred for care provided by a psychologist, psychiatrist, psychoanalyst, social worker or guidance counsellor.
“These three categories represent 1.07 million claims per year, out of a total of more than 1.7 million claims,” says Trudel.
He adds that the list of care for which Beneva has removed the requirement for a prescription also includes the following conditions, in descending order of the number of claims in the past 12 months:
- 300,000 claims for massage therapy
- 90,000 claims for acupuncture
- 90,000 claims for podiatry and chiropody
- 50,000 claims for naturopathy
- 15,000 claims for dietetics and nutrition
- 15,000 claims for occupational therapy
Several other types of care for which a prescription is not required each amount to fewer than 10,000 claims per year, Trudel notes.
Revamped form on the horizon?
As for the CLHIA's simplified form, introduced in 2017, Eric Trudel believes it makes life much easier for physicians, “who always have the same questions in the same place, regardless of which CLHIA member insurer they are dealing with.”
According to Trudel, CLHIA members use the standardized disability form when the group plan includes both short- and long-term disability coverage. “However, in a complex disability case that requires specific information to be processed, the insurer usually asks for another form to be completed,” he points out.
There is one main issue with the current form, Trudel says. “The CLHIA will eventually have to develop a standardized form for long-term disability situations without short-term coverage.”
Trudel says Beneva has many group plans where the employer self-insures for short-term disability, often in the public sector, making the standard form unusable. Beneva, which was formed by the merger of La Capitale and SSQ Insurance, claims to be the largest mutual insurance company in Canada, with more than 3.5 million members and clients.
