Ottawa mother with son living with autism denied thousands of dollars in claims

An Ottawa mother says it’s been a nightmare dealing with her insurance company after she was denied tens of thousands of dollars worth of claims for her autistic son’s therapies.

“He had a brain injury at birth and then later received an autism diagnosis, so we’ve had numerous care needs for him for the last many years,” said Sophie Barrette.

Each year Barrette takes her six-year-old son to hundreds of appointments for various therapies, including speech and occupational therapy.

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Three years ago, she opted-into Beneva insurance through her work, as a secondary provider.

She pays $6,000 in premiums per year and says she has had nothing but trouble from the beginning.

“In 2021, my claims were paid eventually. But that was after numerous attempts to have them paid properly,” said Barrette.

“They would come back as denied, they would come back as invoices, not submitted, underpayments throughout the entire year, it was a lot.”

The next year she started suffering from caregiver burnout and in April 2023, CHEO wrote a letter of support to Beneva asking to exempt Barrette from the 12-month window to submit her 2022 claims.

“I was on sick leave at work, really unable to cope with everything,” she said. “I was not doing well with my own mental health.”

When she did submit the claims earlier this year, along with additional letters of support, she says she was initially approved over the phone to be exempt from the 12-month window by Beneva, before being denied in an email the next day.

“The decision was made to decline my claims based on the fact that they’re saying I was actually never entitled to sign up with this insurance company, which is the first I’ve ever heard of it,” she said.

“I have a letter saying that they've accepted me into the insurance program. In 2021, they have accepted every single one of my premiums. I continue to pay premiums at $6,000 a year. But they will not pay the claims that are outstanding.”

She says there are over $20,000 outstanding in denied claims and that doesn’t include 2023 or 2024 or money owed through her third insurance provider.

“There is no timeline, no deadline, no assurances that I'll be receiving any money for my 2023 claims,” said Barrette.

“I was just advised now of how I could even go about submitting my 2024 claims, because prior to that, I was blocked from submitting from the portal.”

She says because of the sheer volume of claims, Beneva is asking her to now submit claims through the customer centre.

But she says her request to have a customer service representative assigned to her file to help with the process for both previous and future claims was denied. 

“They're saying that my claims are too complex. They're not complex. My claims are very straightforward,” said Barrette. “But I do have a very heavy volume of claims. Currently, if we're talking about this week, I have 11 claims to submit per week. So it's a lot.”

In a statement to CTV News Ottawa, Beneva says, “At Beneva, all our clients are important for us. However, for confidential reason, we cannot comment a specific case.”

In total, Barrette says she is out upwards of $30,000 in outstanding claims, which includes claims from 2023 she submitted in both March and April of this year.

“The problem now is that I'm blocked from my third insurance provider because I cannot proceed with my third insurance without having an outcome from my second insurance,” Barrette said.

In the meantime, she says the 18-month window she has to submit claims to her third insurance provider has passed.

She says unless things clear up with Beneva and they write a letter to her third insurance provider explaining the situation, she will be unable to submit with that provider. 

“It’s very heavy. I'm off work right now. I'm on sick leave for the last two weeks,” said Barrette. “We’ve had our hands full and I have a lot of money outstanding so I can’t really provide (my son) what he needs right now."