Appealing denials of prescription coverage
UNA and HBA Services, representing the Health Regions, have issued a further joint statement on prescription coverage and on how to appeal a denial of coverage of a prescription. This is in addition to the process announced earlier to handle claims that were filed before February 1, 2006.
An employee who wants to appeal a claim for a prescribed medication denied by the insurance company, needs to complete the Medication Claim Denial Appeal Form. These forms are available from Employers and UNA representatives.
To be approved, the medication must be dispensed by a pharmacist, and prescribed by a physician or dentist to correct or treat a medical condition based on a diagnosis made by the physician or dentist.
The deadline for appeals of claims from before February 1, 2006 was April 30, so this new process must now be used.
To get a form contact your Local or you can reach your Employer contact for the Medication Claim Denial Appeal Process. This document has a listing of Employer contacts: Employer Designate Listing.pdf
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