[Discussion] the Ontario answer is not the Alberta answer
the Ontario answer is not the Alberta answer, which sounds obvious until you try to state the evidence for it.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Special authorization is a documented exception process with published criteria. Applications that answer those criteria explicitly, point by point, fare better than general clinical narratives.
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
Would rather be corrected in public than confident in private.
best — the order this archive was captured in
A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies. The first can be an administrative or quantity issue; the second is a determination you can appeal.
Kept every form and reference number. When they had no record of a submission, I did.
Agreed on keeping every form and date. When something goes wrong the paper trail is the whole case.
Push back: approval by the national regulator says nothing about whether any plan will pay.
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.
compare cash prices before assuming coverage is the only path
Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the appli
ferritin_low is right that a rejected claim and a denied authorization are different animals.
a rejected claim is not the same as a denied authorization
Provincial plan, employer plan, or paying cash?
Same view — private and provincial plans are genuinely different processes with different appeal routes.
ask the pharmacy what the cash price is, it varies
Pharmacy staff name removed. The pharmacy can stay in a pricing post.
- 1Formulary criteria are revised, and plan renewal is a natural point at which…8 comments in this branch · started by u/ferritin_low