Ineligible service providers, clinics and associations
As part of our commitment to you, iA Financial Group (Industrial Alliance Insurance and Financial Services Inc.) remains diligent in fighting misuse and improper claims practices to make sure that valid services are received and costs are kept as low as possible.
We regularly review, audit and investigate services in accordance with our administrative practices and the terms and conditions of our group policies, to delist any service provider, clinic and provider association that can have a negative impact on group insurance plans.
Here are some examples of the many reasons that could lead iA Financial Group to determine that a service provider, clinic or association is ineligible:
- A service provider/clinic that issues a receipt with false information or for services never rendered
- A clinic that issues a receipt with the name of a service provider who did not provide the service or who does not work at the clinic
- A service provider/clinic that provides products such as fashion shoes and handbags falsely claimed as orthopaedic appliances or other items covered under the plan
- A service provider/clinic that uses profit-motivated marketing and advertising to promote the use of insurance benefits for services and items that are not medically necessary
- A service provider/clinic that bills for services outside of the provider’s scope of practice/field of work, such as lifestyle programs (e.g. gym memberships, personal training, beauty/spa treatments, non-therapeutic or non-medical massages - this situation stems from a lack of government regulation for the services of certain professions)
- A service provider/clinic that inflates charges when there is co-insurance or does not bill the patient for the balance of the charges not reimbursed by insurance
- An association that accepts service providers as members who do not have the appropriate training or qualifications and/or who are associated with non-accredited schools
If we identify a clinic as ineligible, this means the affiliated or related providers at this clinic are also ineligible.
If we identify an association as ineligible, this means the providers who are members of this association are also ineligible.
When a service provider, clinic or provider association is identified as ineligible, it means that the services they provide will not be reimbursed under the group policy. It does not mean that a plan member cannot continue to see them, only that their services are not eligible for reimbursement.
How to learn more about a service provider
Before making a claim, plan members can make sure that the service provider has the appropriate qualifications and meets the requirements of the group plan.
Most health regulatory colleges and associations (where the services of the profession are not regulated by a provincial or federal body) have a public register that contains information on the provider’s membership status, including those who are no longer practising. Plan members can check with the colleges and associations whether there are any concerns related to the provider’s conduct, competence or ability to practise their profession.
Communication to plan members
To inform your plan members about the update on ineligible service providers, clinics and associations with iA Financial Group, please forward them the attached communication. The communication is also available in My Client Space.
If you have any questions, please contact your advisor or your iA Financial Group Account Executive.