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
• Medical Supplies & Equipment
• Medical Transportation Benefits
• Mental Health
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
• 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
APPEAL Level 3
First Nations Health Authority
#501 – 100 Park Royal South
West Vancouver, BC - V7T 1A2
An appeals procedure for Pharmacy is being finalized. Information about the appeals procedure will be posted on our website once it is available.
Do you have questions?
Contact us at:
1.800.317.7878 (Toll Free)
1-800-317-7878 (Toll Free)
Download a print version of the FNHA Health Benefits Client Satisfaction Survey
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