Doctors Orders vs Insurance Company

[HunterDave]

Well, I've vented and I emailed so now it's just a matter of waiting for their reply. I'm a lot more calm about it now. Exert from my email to Client Relations Team, Manulife:

"I will say this, in no uncertain terms, XXXX will be following her Doctor’s recommendations/orders for her recovery and NOT those of Manulife’s or anyone that is employed by you. Our Doctor is the only individual that is fully aware of what XXXX’s health related requirements are, NOT anyone at Manulife."

"Should you chose to reduce or deny any or all of her Manulife benefits you can be assured that I will pursue her entitlements vigorously."

"My wife will not be accepting any more phone calls from any representative of Manulife as it is detrimental to her full and speedy recovery from her surgery. DO NOT CALL OUR HOME AGAIN!"

"Communication via email at this email address is the preferred method of communication."

[Badgoodguy]

If any BS contact the ombudsman's office plain and simple or if that doesnt work always just drop the word press they hate TV etc

[ali#1]

Originally Posted by HunterDave

Well, I've vented and I emailed so now it's just a matter of waiting for their reply. I'm a lot more calm about it now. Exert from my email to Client Relations Team, Manulife:

"I will say this, in no uncertain terms, XXXX will be following her Doctor’s recommendations/orders for her recovery and NOT those of Manulife’s or anyone that is employed by you. Our Doctor is the only individual that is fully aware of what XXXX’s health related requirements are, NOT anyone at Manulife."

"Should you chose to reduce or deny any or all of her Manulife benefits you can be assured that I will pursue her entitlements vigorously."

"My wife will not be accepting any more phone calls from any representative of Manulife as it is detrimental to her full and speedy recovery from her surgery. DO NOT CALL OUR HOME AGAIN!"

"Communication via email at this email address is the preferred method of communication."

Good for you.

I have learned the hard way that dealing with these people you can not be subtle say what you want to say and don't be afraid.

[Badgoodguy]

Hey Hunterdave if they call again ask for their # and name for reference

[Gunfighter]

Originally Posted by ali#1

Exactly. I can't wait til someone's mom/wife/child is denied medical care.

Didn't hear that medical care was denied just too to pay for recovery so...
But that you have paid for that service so until the doctor says back to work , wouldn't happen

[TreeGuy]

First off. Merry Christmas to you and your's, Dave. May your lovely (and I suspect tolerant) wife have a speedy recovery. LOL

Secondly. Mrs Tree was rushed in for an emergency surgery this October. I was working almost 1000km away. I am very, very fortunate to work for an amazing employer that allowed me to be on the road home within an hour with relief on the way.

Had she been subjected to similar treatment I can pretty much assure you I would not have conducted myself with such restraint and grace. Kudos to you good sir. You have my respect.

[winged1]

during my 10 year tenure of working with unionized employes in Vancouver, we paid attention to numerous, questionable health claims. Insurance companies, as do many employers affected, will often validate medical claims through private practitioners. Fraud is too wide spread to not take action. There are many claimants that require assistance, however, the abusers are making it more difficult for genuine cases.

Be firm, but don't be offended. Understand that there is a huge amount of fraud going on.

[Okotokian]

Originally Posted by HunterDave

"Communication via email at this email address is the preferred method of communication."

Has your wife made you her legal representative? You realize manulife can't discuss her case with you. So they aren't going to be sending anything anywhere unless your wife tells them to in writing. Personally I would not deal with them directly. Let her write them. You can coach her on what to say, but have it come from her. You have no legal status in this.

And where is her employer in all this? THEY are manulife's customer.

[moosemad]

Originally Posted by HunterDave

A little bit of a rant here.....

My wife had surgery a couple of weeks ago and the Doctor recommended and signed her paperwork for her employer for her to convalesce until Jan 19th. I get home today and my wife is in tears from a phone call from Manulife. Someone there called and said that they want her to return to work next Monday on light duties if she needs to. WELL, needless to say I sent an email to their client services department informing them that my wife would be following her Doctors orders and NOT be at work on Monday, AND who the hell do they think they are to think that they know better about her health than her Surgeon? I'll see what their response is but they're gonna have one hell of a fight on their hands if they attempt to reduce or deny any of her benefits.

Anyone ever have a similar situation with an insurance company that might give me an idea of what I might expect?

Hope your wife is feeling better. Going through the same thing with my son and Sunlife, doctor says he is unfit to return to work, saw a specialist and is being referred to a specialist surgeon in the field although this takes time. My son has not received any compensation since Oct 18/13. Latest update is the claim is under review and we may know in 10 days or so. Real nice when you have a young daughter, mortgage payments, insurance, utilities, groceries, etc two weeks before Christmas.
Worse part is the claim manager is very smug and egotistic, I sent an email hoping she never has to deal with this type of situation with one of her children. Not everything is brighter under the sun.

[dgl1948]

I managed the benifit plan for a large company before retiring. One of the problems with Doctors is they very often do not provide the information an insurance company requires. Just a note to be off work is not good enough. Each condition has a set standard for recovery within the medical community. If the recovery is outside of this set time then the conditions and time frame for this must be justified. There can be a lot of problems with getting this extra information as they may be sent to other doctors and that takes time. Here again each of these steps have set time frames within the medical community. At each step the insurance company is going to require documentation, not just a note. Their medical people are checking to see if the person's doctor is providing an approved treatment plan that is acceptable within the medical community.
In most of the cases I had to deal with the bigest problem was getting a doctor to provide the proper documentation. Most were very good but the odd one was not worth a pinch of you know what. I had one fellow that the doctors note said he was to be off work for an extended period of time but the doctors paperwork still said he could play hockey??? I used to get all kinds of notes from empoyees who had been to a doctor and would send a note in saying they were to be off for an extended period of time but provide no information or completed insurance forms. The employee must do their part by making sure the I's are dotted and the T's are crossed and do any follow ups required. Lots of people were reluctant to go to a doctor and get the extra paperwork required as the doctor would charge for this service. In most cases where there was a requirement for more than normal documentation neede by the insurance company they would look after the extra charges.

When there is light duty work there is an agreement with the insurance company and the empoyer. There has to be meaningfull work that will not harm or delay recovery. In lots of cases this even speeds recovery. Here again a doctor must provide documentation outlining the limitations of the recovering party. If the employer does not follow the outlined revovery plan for the light duty work, they could the be held accountable for any further problems that may develop.

I am not sticking up for these insurance companies, just trying to point out a few of the issues. And for those that want to lawyer up right away, you are going to look awfull foolish if all the doctors documentation says" this individual should be off work for three weeks"