The Rush to Use Up Insurance Health Benefits

I am reprinting an article found in the December 21 2010 issue of the Globe and Mail on the Christmas health benefits rush.  The original article can be found here.

The receptionist gave Dawn Wentzell the bad news.

“I was shocked that they were like, ‘She’s booked till January,’” Ms. Wentzell, a 30-year-old Internet marketer, says. She usually never has trouble scheduling an appointment with her massage therapist in Guelph, Ont. with just a few days’ notice.

Then she looked the calendar. Right. It was mid-December.

Cue the frantic appointment-making from the office drones who may not actually have aches and pains but just want to use up their extended health care benefits before the end of the year. ’Tis the season for spiked eggnog and tinsel, but also for fluoride treatments, contact lens prescriptions and hour-long Swedish massages. Adopting a “use it or lose it” attitude, many workers try and squeeze in those last-minute visits to use up their health credits – if they can actually get in to see that dentist/optometrist/massage therapist.

They’ve come to expect the end-of-year “benefit binge” at Julie Paris’s dental clinic in Toronto and the sometimes unreasonable demands from patients. In the last few weeks, staff have worked through their lunch hours to keep up with the full slate of cleanings and fillings.

Besides patients who want to cash in their health credits, extra business also comes from post-secondary students who are home for the holidays and have a narrow window in which to see the dentist, the doctor and the optometrist – often on their parents’ plans.

Lina De Francesco, the clinic’s administrative assistant, is on the front lines when patients call to book last-minute appointments.

Some of the more desperate ones, when told by Ms. De Francesco that no, there are no openings till January, have sent their pleas to the dentist herself via e-mail.

“Everyone wants first or last [appointment] of the day,” she says. “It’s chaotic.”

The only reason Kevin Parnell, 30, was able to score a mid-December dentist appointment is because he works as a freelance writer and programmer and has a flexible schedule.

The Torontonian had been without dental insurance for four years until this year, when his girlfriend put him under her benefits plan, which covers 80 per cent of treatments.

Not knowing the year’s allotment of up to $1,500 (for the two of them) expired at the end of the calendar year, he dragged his feet on making the appointment for the long-overdue exam. It also didn’t help that a friend, who’d also put off seeing the dentist for four years, was told he needed an emergency root canal when he finally had a dental exam.

Last week, his girlfriend pushed him to book soon and by luck he called and landed an appointment for the middle of the next day.

“I was telling them I was so surprised I got in,” he says. “They’re getting rammed … They said I was probably the last person that was going to happen to. They’re booking for the end of January.”

In step with that end-of-year flurry of appointments are the claims sent to insurance providers.

At Manulife Financial’s group benefits division, employees see the “shoebox effect” in December and January: an increase in claims from people who have put off filing them until the end of the year.

Joanne Keigan, the Halifax-based vice-president of group operations with the insurance provider, says the fact that many plans include a dollar amount to spend on specific types of benefits (such as naturopathic medicine or massage therapy) adds to the effect.

“These accounts do have deadlines, so it’s natural to see people checking their balance and ensuring they use up their credits before they expire,” Ms. Keigan wrote in an e-mail.

Shondrel MacMurdo, the office manager at Apex Massage Therapy in Calgary, can usually tell the regular clients apart from the ones who have consulted their balances at the end of the year.

“In December, we see people who don’t typically come to the clinic come in week after week.”

Instead of the $60 “self-care” treatments (“to maintain wellness and prevent injury or overuse”), they indulge in the $120 “What you want” full-body massage.

“A lot of people say, ‘I’m trying to use my benefits. They laugh and book themselves for the month.”

As for Ms. Wentzell, after accepting that she wouldn’t be able to have the tension kneaded out of her till the new year, she received a call last week from her massage clinic’s receptionist. There was a last-minute opening following a cancellation.

“I don’t know who was stupid enough to give up that appointment but I’ll take it,” Ms. Wentzell says.