It’s well known that insurance companies are in the business of making money, and that some of them will stop at nothing to try and restrict or eliminate the reimbursements they are obliged to pay to their policyholders under the terms of their contracts.

In fact, with the number of naturopathic consultations estimated to have doubled in the last decade, and naturopathy the most popular insurance coverage in Canada, it’s easy to understand why SSQ/Beneva, Sunlife and Industrial Alliance discourage their policyholders from consulting naturopaths by refusing to honour their policyholders’ contracts, to increase their profits.

As an example of insurance companies’ desire to increase their annual profits, in 2014, Industrial Alliance and Sun Life decided to no longer honour receipts issued by naturopaths who do not display, in full view of their clients, their academic diploma.

It is for this reason that the CPMDQ, through its naturopathy college, has since decided to offer its members academic equivalence, enabling them to continue issuing insurance receipts under the cover of naturopath, in full compliance with the terminological definitions of the WHO and the Office de la langue française.

Since group insurance contracts are made up of three distinct parties: the employer, the policyholder and the insurance company, and since only the parties to the insurance contract have full power of contestation, there is nothing to allow you, as a service provider or professional association, to contest the refusal of reimbursement by your customer’s insurer.

However, since an insurance company is governed by the Insurance Act, it is legally bound to respect the terms of its insurance contracts, and given that the various approaches and practices of alternative medicine are not regulated by the Quebec government, and that the only condition for a service provider to be fully eligible to issue insurance receipts is that he or she is a member of a professional association corresponding to the coverage indicated on the receipt, we can conclude that the insurer’s refusal to pay, whatever the reason, is likely to be without legal foundation.

Especially since CPMDQ insurance receipts contain all the information needed to facilitate reimbursement by the insurer, and since it is possible for the insurer to confirm the status of a CPMDQ license via the CPMDQ website, an insurer does not need your address, nor to require you to register on its platform to proceed with reimbursement of the claim submitted by its insured.

So, if an insurance company asks you to register on its platform, or asks you to provide a copy of your diplomas, or to add your contact details on the receipt, on the basis that this information is necessary to reimburse the claim, please do not submit to this request, as by cooperating you are authorizing the insurer to conduct an investigation on you in an attempt to justify its unfounded reason for refusing reimbursement, So, to avoid being blacklisted as a service provider by insurers, we recommend that you never communicate with your customers’ insurance companies because in any case, any refusal of payment for services rendered can only be contested by the parties to the insurance contract.

Regarding the SSQ/Beneva/Capital reimbursement rejections, as explained on the “CPMDQ vs. SSQ” page, which you can consult by clicking on the link at the bottom of this page, SSQ, in its 2013 assessment of the quality of services offered by healthcare providers in Canada, suddenly decided, without prior notice to its policyholders, to remove from its list of providers the members of some 80 professional associations in Canada because it was incurring significant financial losses associated with the reimbursement of care that, in its view, was unnecessary and was provided by unqualified therapists who did not meet the standards and criteria established by it. This is although, in the absence of regulations governing the practice of alternative medicine in Quebec, it is impossible for an insurer to legally impose its own standards or criteria on professions that are not governed by the Quebec legislature.

We can therefore understand why, at the CPMDQ v. SSQ hearing, the judge made it clear to SSQ’s legal representatives that, if the insured contests the refusal of reimbursement in Small Claims Court, the insured will certainly have a good chance of prevailing. This explains why, since 2014, many policyholders have obtained reimbursement shortly after sending their formal notice to their insurance company, without having to turn to the courts because in reality, an insurance company does not want to be sued when its position is not legitimate, or when its arguments are not convincing.

Considering the foregoing explanations, when your client’s insurer refuses to reimburse him for his claim, whatever the reason given by the insurer, you should direct your client to read the contents of the “Refusal of payment by an insurer” page, the link to which can be found at the bottom of this page.

CONFIDENTIALITY NOTICE

This page contains information that CPMDQ Members can only access through their accounts. The dissemination, printing, or reproduction of the contents of this page to individuals who are not members of the CPMDQ is strictly prohibited and unauthorized.

LINKS FOR POLICYHOLDERS

Insurers & Public section
REFUSAL OF PAYMENT BY AN INSURER

Insurers & Public section

Court File & Judgment (CPMDQ v. SSQ)

Insurers & Public section

CHECK THE STATUS OF A CPMDQ LICENSE

INFORMATION RESERVED FOR CPMDQ MEMBERS

Member Account

POLICY ON THE PRODUCTION OF INSURANCE RECEIPTS

This page contains information that CPMDQ Members can only access through their accounts. The dissemination, printing, or reproduction of the contents of this page to individuals who are not members of the CPMDQ is strictly prohibited and unauthorized.

Member Account

CPMDQ ACADEMIC EQUIVALENCE

This page contains information that CPMDQ Members can only access through their accounts. The dissemination, printing, or reproduction of the contents of this page to individuals who are not members of the CPMDQ is strictly prohibited and unauthorized.