⚙️TBT—Part 3: Why Benefit Problems Happen (and How to Solve Them)

In Part 2, we covered what your benefits include. But having coverage is only half the journey — accessing benefits and processing claims is where many members hit a roadblock.

We rarely think about our benefits when they’re working seamlessly for us — and that’s the way we’d like it to stay. But just like a roadblock forcing you off course, frustration hits when the unexpected slows you down.

In Part 3, we’ll look at why problems happen — from long wait times to denied claims — and how to keep things moving.

Common Issues and How to Navigate Them

So… You’re Running Into Problems?

Anyone who’s planned a trip knows that even with a clear route, smooth travel isn’t guaranteed.

Wrong turns, bad weather, or unexpected bottlenecks down.

So we’re taking a closer look at some of the most common issues members experience.
What’s really causing them?
And how do we navigate them effectively?

1. Long Wait Times

Approvals and reimbursements can feel like being stuck in interstate traffic — you should be moving, but you’re not.

Common causes:

• Delays from doctors or specialists sending information

• High claim volumes during peak times

• Delays in employer-submitted hours, causing backlogs in eligibility

• Eligibility delays during the probationary period (about 700 hours)

What to do:

• Connect early with McAteer to confirm required documents.

• Submit everything together in one package.

• Inquire about standard processing times with all key entities involved in your claim.

• Ensure your employer submits hours promptly and accurately.

• Review the eligibility details for your insurance coverage’s standard probationary period

2. Denied Claims

The #1 cause of denied claims? Missing documents — such as doctor’s notes or referrals.

For disability claims (for example, short-term disability after surgery) the insurer may need additional details from your healthcare team to process your claim. This may include medical history, projected recovery time, and related records. Often, this information can be faxed directly from your healthcare provider to the insurer.

What to do:

• To avoid delays confirm what documents are required before submitting.

• Ask healthcare providers to fax records directly and provide a send receipt.

• Check eligibility in MemberXG with the “Check Eligibility” feature before filing.

• Run a mock claim in GreenShield+ to see your reimbursement.

3. Delays and Overlap in the Chain of Responsibilities

The route to accessing your benefits has several relay points — you, your employer, your healthcare provider, McAteer, and others.

Depending on what you’re seeking coverage for, delays at any point can create backlogs and ripple into further delays down the chain.

Claim Process Example:

Member requests coverage for a therapeutic service (e.g., massage) → The Health Plan requires a doctor referral → Member books appointment → Physician provides note → Healthcare team faxes note to insurance → Insurance processes claim → Member receives reimbursement.

Examples of Possible Delays:

• A doctor’s note faxed late delays the entire process.

• An employer is late in submitting working hours, which delays the members eligibility.

• Insurance has a 2-4 week processing time due to backlog processing claims.

Even small issues — like a referral not being faxed promptly — can cause significant delays or denials. Unavoidable lags, such as long weekends, can also contribute to slower response times.

What to do:

• Check in with all parties on what documentation needed

• Keep proof of documentation submitted.

• Follow up to ensure documentation is received.

• Log names, dates, and claim numbers.

4. Delays in Eligibility

Another common, headache-inducing issue is delays in eligibility. It’s not uncommon to have confusion around how and when you become enrolled in benefits.

Myth: Benefits kick in after a 3-month probation period.

Fact: Eligibility begins after 700 verified work hours, once those hours are received and confirmed by your employer, union, and McAteer.

You’ve likely heard that benefits start after 700 hours (Or roughly three months) — but that doesn’t mean benefits start immediately. Employers must first submit those hours; then, McAteer must reconcile them before coverage activates.

In practice, full eligibility usually takes 5–6 months.

How your hours become enrolment in the benefits program:

Employees work their set hours → Employer submits hours and contributions negotiated under the collective agreement → McAteer reconciles → Union funds the plan → Member is enrolled

If one step in this process lags — for example, if your employer submits hours late — the rest of the process will face similar delays.

Tips:

• Track and submit your working hours accurately and promptly.

• Confirm your employer submits your hours promptly.

• Expect 1–2 months for McAteer processing after 700 hours.

• Call to confirm your enrolment status.

Good news: once you’re enrolled, coverage stays active as long as you remain eligible.

In Summary

Delays happen, and miscommunication can make them worse — but understanding how the system works helps you tell the difference between a normal delay and a real problem.

📥 Download today’s resource: “Eligibility Timeline Guide” — a simple visual that maps your path from work hours to active benefits.

Then check back for Part 4, where we’ll explore how to beat paperwork fatigue and make the most of your digital tools.