Back in December I submitted a claim for orthopedic shoes since my benefit plan Great West Life allows for that. There was a bunch of paper work that had to go back and forth in order for me to get my first pair. Paper work that included a doctors note and then an assessment claim that was submitted to Great West Life in order to see if the amount would be covered. I received a letter back stating that I would be covered for the full $750.00. So on Dec 13th 2010 I had my appointment, and the paperwork was sent off. On Jan 7th 2011 I received payment from Great West Life via direct deposit for the full $750.00, I then paid the provider of the orthopedic shoes on Jan 13th 2011 the full $750.00.

Since I’m eligible every calendar year I decided that I would order a second pair to wear while I’m indoor at home. On Feb 10th 2011 I had an appointment with the same provider and the paper work was sent off for my second paid of orthopedic shoes. On March 7th 2011 I received via direct deposit $500.00. I decided to call and inquire as to why the full $750.00 amount was not eligible and I was told that “Benefits are limited to representative pricing in the area” which basically means that I’m not covered for $750.00 but for $500.00. I received a phone call informing me that because the second paid was not made from custom imprints of my feet but from recycled prints I was not eligible for the full amount. So I called the provider of the orthopedic shoes and informed them of this, they were amazing an adjusted the amount to $500.00 so on March 8th 2011 I paid the provider $500.00.

Yesterday; March 28th 2011 I received a letter from Great West Life regarding my Dec 13th 2010 claim. The letter states that my submitted expense is $750.00 however my eligible expense is $500.00 due to “Benefits are limited to representative pricing in the area” and that a cheque for $500.00 is being sent to the provider of the orthopedic shoes.
This confused me, since I already received the $750.00 and paid the claim with the money that I received, so I called Great West Life and asked what was going on. Basically no one could tell me anything because the person that dealt with my first inquire into why the amounts approved were different was not there. I was told that I would receive an answer by Wednesday evening.

This evening I opened up another letter from Great West Life. It states the following.

On Jan 6th 2011, a $750.00 health claim overpayment was made.
Our file shoes that the claim has an assignment of benefits to the provider of services. Inadvertently, the cheque was issued in your name. We apologize for an inconvenience this may have caused.

It would be appreciated if you could send us a cheque, payment to Great West Life, in the amount of $750.00, to settle the full amount of the overpayment by April 21st 2011.

(want to read the rest..click HERE)

Basically, Great West Life want’s me to pay them back because they fucked up, approved a claim for $750.00, then paid me the full $750.00 when in fact that claim should have been approved for $500.00 and been paid to the service provider.

The $750.00 and the $500.00 that I received for both claims from Great West Life was paid to the service provider by me, so by them issuing a cheque to the service provider now is pretty redundant, and it’s insulting for them to ask for the money back from me.

I’m hoping that tomorrow when I explain all this Great West Life realizes that I will not be sending them a cheque for $750.00 and that the cheque that they have issued and sent to the service provider for $500.00 should have a stop payment placed on it. Everyone’s already been paid!
It’s not my fault if I was approved for an amount that I should not have been approved for. That’s their error. Why should I be penalized.

What do you think? Am I in the wrong here? Do I make sense? Should I have to pay back the $750.00?