[Question] does anyone have the special authorisation criteria in writing
does anyone have the special authorisation criteria in writing. Searched first, found three threads that contradict each other, hence the post. Special authorization is a documented exception process with published criteria. Applications that answer those criteria explicitly, point by point, fare better than general…
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.
Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Was this a denied authorization or a rejected claim?
Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
That is an employer plan process, and the provincial route is different in both form and timeline.