[Private Plan] my plan added a lifetime maximum halfway through my year
my plan added a lifetime maximum halfway through my year, and I am aware this is a minority view on this board. The three separate questions people ask here as though they were one. Is it approved for sale — a national regulatory question with one answer. Is it covered — a provincial or private-plan question with…
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary.
rania_diallo is right that a rejected claim and a denied authorization are different animals.
Plan and policy numbers redacted from the screenshot above.
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
Have you asked the pharmacist to check?
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the applicant changing.