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Appeals

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What do I do if I have been denied approval to access a Health Benefit?

When coverage for a benefit has been denied, the recipient or parent/guardian of the recipient has the right to appeal the decision. The following benefits can be appealed:

• Dental
• Medical Supplies & Equipment
• Medical Transportation Benefits
• Mental Health 
• Vision
• Pharmacy

Note:  Benefits excluded from the program cannot be appealed.

What is the process for appealing?
The recipient (or parent/guardian) is asked to forward a letter of appeal and supporting documentation by mail. There are three levels of appeal available. 

Your letter of appeal must include: 

• The condition for which the benefit is being requested
• The diagnosis and prognosis, including what other alternatives have been tried
• Relevant diagnostic test results (ex: dental x-rays)
• Justification for the proposed treatment and any additional supporting information

If an appeal is denied and new information becomes available later which supports your claim, your appeal can be escalated to the next appeal level.
 
Upon receiving the submission, the FNHA Health Benefits program will arrange to have the case reviewed by the relevant appeal level and the decision will be made based on the specific needs of the recipient, accumulated research, the availability of alternatives, and the FNHA Health Benefits program policy and/or professional review. 

The recipient or parent/ guardian will be provided with a written explanation of the decision made. 

For more information on the appeal process or the status of your appeal, please contact the FNHA Health Benefits office at 1.800.317.7878.

Please forward your letter of appeal and supporting documentation by mail, clearly marked "APPEALS - CONFIDENTIAL" to the address listed below, according to your level of appeal.

APPEAL Level 1
Director, Health Benefits Operations
First Nation Health Authority
#540 - 757 West Hastings St
Vancouver, BC - V6C 1A1
 
APPEAL Level 2
FNHA Health Benefits Appeal Review Committee
Attention: Vice President, Health Benefits
#540 - 757 West Hastings St
Vancouver, BC - V6C 1A1
 
APPEAL Level 3
CEO
First Nations Health Authority
#501 – 100 Park Royal South
West Vancouver, BC - V7T 1A2


Appeals Procedure for Pharmacy

APPEAL Level 1:
NIHB Drug Exception Centre
First Nations and Inuit Health Branch, Health Canada
Health Canada
200 Eglantine Driveway, 2nd floor
Tunney's Pasture, Postal Locator 1902D
Ottawa, ON - K1A 0K9
 
APPEAL Level 2:
Benefit Management and Review Services Division
Non-Insured Health Benefits
First Nations and Inuit Health Branch
Health Canada
200 Eglantine Driveway, 2nd floor
Tunney's Pasture, Postal Locator 1902D
Ottawa, ON - K1A 0K9
 
APPEAL Level 3:
CEO
First Nations Health Authority
#501 – 100 Park Royal South
West Vancouver, BC - V7T 1A2​​

 Do you have questions?

​Contact us at 

HealthBenefits@fnha.ca 

or call 

1.800.317.7878 (Toll Free)

 How was your experience?

We want to hear from you about your experience with FNHA Health Benefits. Please take 5-10 minutes to fill out our survey here:

​Feedback ​

​This client satisfaction survey will help us understand BC First Nations experiences accessing FNHA Health Benefits. We will use this information to improve the quality of our services.​
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