Diplomats’ union asking court to make feds fix medical insurance

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OTTAWA — The union representing Canadian diplomats is asking a judge to force the government to fix its employee health insurance after “significant systemic problems” have forced some public servants to fight tooth and nail to be reimbursed tens of thousands of dollars in medical expenses.

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Jan Scazighino, a senior trade commissioner at Canada’s Consulate General in Detroit and 32-year employee at Global Affairs Canada (GAC), is discouraged.

Since the federal public service switched its employee health insurance provider on July 1, 2023, to Canada Life and its subcontractor for overseas claims, MSH International, he’s had to fight for months to be reimbursed for his medical expenses — if they are reimbursed at all.

More than one year after the change, Scazighino says the total value of his pending claims with MSH International has ballooned to over $8,000 and that he’s avoiding going to the doctor because the cost is becoming unbearable.

“I cannot afford to rack up this deficit much longer,” he told National Post. “If this is not resolved, I cannot stay here knowing that I cannot get reimbursement for my health care. So, I would most probably leave early.”

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“Why is GAC hurting itself and Canada by not resolving this problem?” he asked.

Meaghan Sunderland is in the same boat. The senior diplomat at Canada’s Consulate General in Boston says she’s practically a forensic accountant after the countless hours she’s spent tracking her claims and refunds with MSH International.

In some cases, she says claims she made after the switch to MSH simply disappeared. In other cases, she would be reimbursed for only part of her claim while the rest appeared to be forgotten by the company.

In July, she had over $20,000 USD in unpaid claims pending with MSH International and a binder over one-inch-thick overflowing with the related paperwork. A few months later, that amount has shrunk by half, but she’s still pulling her hair out trying to get reimbursed.

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“This is unprecedented. I have 20 years in the foreign service, I’ve spent the bulk of my career posted in the United States. So, I’ve been dealing with comprehensive coverage throughout those years, and this has been the most dismal that I’ve seen it,” she said in an interview.

“Routine visits for a family of four (optometrists, pediatrician, mammograms, physiotherapy) quickly add up, leaving us constantly in the hole for thousands of dollars,” she added later by email.

Sunderland and Scazighino are far from alone, says Professional Association of Foreign Service Officers union president Pamela Isfeld.

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Since the government switched insurance provider to Canada Life and MSH International, Isfeld has heard from countless of the 2,000 active and retired foreign service members about their struggles to be reimbursed for their medical expenses abroad.

“Employees pay half the premiums, and all of that money is still being deducted from everybody’s pay while this service is widely known to be non-functional,” Isfeld said.

In February, CBC reported that the heads of all Canadian missions abroad signed a joint letter denouncing the “untenable” situation with MSH International.

The problem is so bad that GAC set up an emergency medical advance system early this year for its employees who were unable to get quick medical coverage abroad.

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To date, the department has advanced nearly $5.5 million to its staff, with just over $3.3 million since reimbursed, GAC spokesperson Charlotte MacLeod said Tuesday.

So last week, PAFSO filed a lawsuit asking the Federal Court to declare that the government is violating its legal duty to provide a “functional health care plan” to its employees and require it to fix the situation as soon as possible.

“Since the transition to MSH and Canada Life, the (Treasury Board) has failed to ensure that the health care plan was functional and meeting the needs of Plan members, has failed to ensure that MSH was adequately prepared to implement the Plan, has failed to supervise MSH’s implementation of the Plan, and has failed to respond in a timely or appropriate manner when issues arose,” reads the lawsuit obtained by National Post.

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“The Plan, as administered by MSH particularly, has exhibited ongoing and significant systemic problems for public service employees,” it continues.

The lawsuit lists over a dozen problems with MSH’s service, including interruptions in benefits, “arbitrary and erroneous” claim denials, random closure of claims without warning, loss of submitted claims and “consistent inability” to get a hold of MSH agents.

The lawsuit is on top a human rights complaint PAFSO filed earlier this summer against the government regarding MSH and Canada Life.

In recent updates to either overseas public servants or PAFSO, both the government and MSH International have said that services are improving.

In a statement to its public services clients last week, MSH International wrote that it is “achieving the expectations set out for us by the Government of Canada.”

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“We continue to work hard on the member experience and are happy to share that claims processing times have greatly improved. Focus remains on working towards consistently achieving the expectations set out for us by the Government of Canada for claims processing service times,” the company wrote.

On a portal for public service employees, MSH says it processes the average comprehensive coverage claim in five days and takes seven days to process emergency travel assistance claims.

It also says its average call centre wait times are 3.3 minutes for regular coverage questions and under one minute for emergency travel assistance issues.

The company also pointed to a revamped online portal that offers a new claim submission process.

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But Scazighino says that has created new issues for him. He says he’s had several claims rejected recently due to a missing “full claim form and signature” despite using MSH’s own template.

“I had used their own MSH online template filling in every box required,” he said in an email. “As such this reason for rejection leaves me baffled and confused.”

In an email to National Post, Treasury Board Secretariat (TBS) spokesperson Ada Bayli argued that MSH has made “notable progress” on call wait times and claims processing.

“Canada Life and MSH are working closely to resolve outstanding challenges that members who are living or working outside of Canada may be facing. The Government is closely monitoring this situation and expect to see ongoing progress,” Bayli wrote.

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But Isfeld, the PAFSO president, is worried that TBS and GAC are burying their heads in the sand. She pointed to an update she received from TBS on Oct. 10 that claimed “there are no claims older than 30 days” with MSH.

Isfeld said that she’s since heard from over 50 members who have claims with MSH that go back as far as July 2023. Scazighino and Sunderland both told National Post they have months-old claims that are still pending with MSH.

“It seems to me like they are deliberately not investigating the scale of the problem, because if they know how bad it is, then they’re going to have to act,” she said.

“This is just not fair, it’s their responsibility and they should be finding out if the service that they are responsible for providing is actually working.”

National Post
cnardi@postmedia.com

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