​​​​​​When coverage for a benefit has been denied, the client, their parent or guardian, or their representative has the right to appeal the decision. This requires writing a letter of appeal that describes the situation in detail. Appeals must be submitted within 12 months from the date the benefit was denied.

Clients must include the following information in their letter of appeal:

• ​The condition for which the benefit is being registered;

• The diagnosis and prognosis, including what alternatives have been tried;

• Relevant diagnostic test results (e.g., dental x-rays); and

•​ Justification for the proposed treatment and any additional supporting information.

There are two levels of appeal available to Health Benefits clients. If an appeal is denied and there is new information that could support it, clients may escalate the appeal and ask for another review within 30 days of the appeal being denied. All appeal materials should be clearly marked APPEALS – CONFIDENTIAL."

Please call Health Benefits at 1-855-550-5454 if you have any inquiries regarding appeals.

Mail all Appeals to:

FNHA Health Benefits Program
540 - 757 West Hastings Street
Vancouver, BC V6C 1A1

Orthodontics Appeals

In addition to the letter of appeal and supporting documentation, orthodontic appeals should include the following information provided by the orthodontist or dentist:

• Orthodontic Summary Form, with HLD Index results;

• Diagnostic test results, including:

o ​Cephalometric radiographs with associated scale for calibration;

o Frontal and profile photographs;

o Intra-oral photographs depicting the right, left, and anterior occlusal relationships;

o Panoramic radiographs; and

o​ Diagnostic orthodontic models.

• Treatment plan, estimated duration of active and retention phases of treatment, and an outline of billable costs; and

• Signature of parent or guardian, including their Band name and status number.

 Health Benefits Contacts

Please do not hesitate to contact us if you have any questions about your benefits.

Phone, Email, Fax
Phone (toll-free): 1-855-550-5454
Fax: 1-888-299-9222
Web: Benefits ​

Mailing Address
540 – 757 West Hastings Street
Vancouver, BC V6C 1A1 

In-Person Enquiries
701 – 1166 Alberni Street
Vancouver, BC V6E 3Z3

Community Relations Team
Fraser Salish Region: James Delorme | Phone: 778-684-1886
Interior Region: Joyce Kenoras | Phone: 250-318-6634
Northern Region: Lindsey Larsen | Phone: 250-960-9201
Vancouver Coastal Region: Jenny Smith | Phone: 604-693-6588
Vancouver Island Region: Vacant 

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