Delisted Health Care Providers

February 19, 2019

Sun Life maintains a national list of eligible service providers, clinics, facilities and medical suppliers. However, from time to time it becomes necessary to ‘delist’ a provider following a careful review and investigation. This means that Sun Life will no longer process claims for services or supplies from these providers. Sun Life has a responsibility to protect the health and wellbeing of members and the integrity of the Plan.

You can still choose to obtain services or supplies from a delisted provider, however, your claim will be denied.

Sun Life’s delisted healthcare service providers list may include medical and dental clinics, facilities and service providers, as well as pharmacies. Information on delisted providers is updated regularly and can be viewed by logging in to your Sun Life Plan Member Services account at www.sunlife.ca/pshcp and selecting “List of delisted service providers” located on the left hand menu. We encourage you to check the list periodically so that you do not unknowingly use the services of a delisted provider.

Healthcare providers and facilities offering inappropriate incentives

Certain types of incentives offered by paramedical providers and medical suppliers can be considered fraudulent. Be wary of promotions or “deals” offered when purchasing medical supplies or services, including free or discounted non-medical items, cash-back, and gift cards. These involve products or services that do not offer clear health or medical benefits and/or cost more than the same product or service obtained elsewhere. These seemingly legitimate incentives are used to entice customers. By accepting such promotions, you may receive medical supplies that are inferior in quality.

Be vigilant and recognize inappropriate incentives. Claims from providers that Sun Life deems to be fraudulent will not be honoured.

What is considered inappropriate?

Incentive

Appropriate or Inappropriate?

Two-for-one prescription eyeglasses.

Appropriate – Prescription eyeglasses offer a medical benefit.

Free pair of running shoes with the purchase of prescription orthotics which are inferior in quality.

Inappropriate – The running shoes do not offer a medical benefit and result in receipt of inferior medically required orthotics.

40% off the cost of compression stockings when purchased at the same time as custom orthotics. Both products have been prescribed by a physician.

Appropriate – Both products offer a medical benefit and have been prescribed.