reading private plan threads from 2024 and half of it aged badly
reading private plan threads from 2024 and half of it aged badly. Not a hot take, just something I have not seen said plainly here. Kept every form and reference number. When they had no record of a submission, I did. The pharmacist sorted in five minutes what the phone line had not managed in a fortnight. Compared…
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
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Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
Disagree — that is your province’s formulary position and it does not carry to another.
a denial letter names a criterion, that is your handle
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.