Health and Social Services
Insured Services Appeal Process for Declined Health Services
Insured Health and Hearing Services recognizes there are times when Yukon residents will require medical services that are not considered insured.
Insured Health and Hearing Services provides an opportunity for residents to request a review of the uninsured service. The procedure is as follows:
- Working in conjunction with their physician, the resident will provide a detailed written letter outlining the issue and the case history. In addition, the resident and physician will ensure any applicable correspondence about the medical condition and the service being requested is included with the request.
- The Manager of Registration and Claims will work with Assessors to determine what Yukon case history may be applicable to the request. In addition, the Manager and Assessors will:
- Consult with Yukon’s Medical Advisor who:
- Will confer with Medical Advisors from across Canada to determine if the procedure is insured elsewhere in Canada or if there is new medical evidence to support a decision to insure the service being requested.
- May take case to the biannual national meeting of Medical Advisors for deliberation.
- Will confer with Medical Advisors from across Canada to determine if the procedure is insured elsewhere in Canada or if there is new medical evidence to support a decision to insure the service being requested.
- Based on the information gathered, the Manager of Registration and Claims will provide the physician and resident with a written response to the request for coverage.
- Consult with Yukon’s Medical Advisor who:
- When a service is declined for coverage by the manager of Registration and Claims the resident may appeal by requesting a review of the case by the Director of Insured Health and Hearing Services, as per Section 5 of the Yukon Health Care Insurance Plan Act. The Director will review all materials provided and may request that the Medical Advisor perform further jurisdictional analysis and medical research. In addition, the Director may research additional sources of information such as the Canadian Agency for Drugs and Technologies in Health (CADTH: http://www.cadth.ca/). The Director will provide a decision to the resident and their physician within 30 working days of receipt of the appeal.
