Insurance Company Demanding Money for Insulin Pump Overpayments


(Xandra) #1

Hi Everyone! I’m brand new here, though I’m hoping to hear from people who have had experience with my particular issue. If you live in Ontario, Canada, I’m definitely looking to hear from you, though anyone’s experience or expertise would be helpful.

I’m a T1 diabetic living in Toronto, Ontario, and I use the Omnipod and Freestyle Libre. I receive $600 every 3 months in financial assistance from the provincial government to help cover the cost of insulin pumps and supplies, and I also have a group plan with my university. I have been submitting both my government grant info and Omnipod receipts to my insurance company since getting a pump two years ago, and from day 1 they have been paying me the full amount on my Omnipod receipts.

However, today they sent me a letter explaining that they have been overpaying me for two years, because their system glitched out and failed to subtract the grant amount. Their actual policy on my claim statements only says that they pay a max of $2000 every 3 months, so I assumed everything was fine. I assumed they knew what they were doing, but now they want me to pay them back $2400 in overpayments from 2017-18. I am a student with less than $10k annual income, and for them to demand I pay them for their mistakes seems very unjust. They had all of the information necessary, including the amount of the grant, and I don’t think I should be held responsible for their failure to follow their own convoluted policy.

I was wondering if anyone has any experience with something like this? I’m concerned they’ll stop processing my claims if I don’t agree to pay them, but I can’t find any information on whether I am legally obligated to do so, or if they are just trying to bully me into it so they can balance their books.


(Elease) #2

That is not right! That is their mistake and the problem is not yours. I’d encourage you to ask to talk to upper management regarding this matter and also write a letter to them explaining your circumstances. I don’t have any experience with this personally but as long as you’re calm and firm with them I hope you get what you want and certainly deserve.