A Verification Situation

Authority Health Insurance BC
Details

With multiple health issues and a variety of personal strains, Reina, a senior, had fallen behind on her paperwork.

After not submitting taxes for several years, Reina received a letter from the PharmaCare program. The letter said Reina’s deductible was being raised to $10,000 per year because the Canada Revenue Agency did not have her tax return – the document used to determine eligibility for coverage. 

Reina could not afford to buy her expensive medicine out-of-pocket, so she called the program to discuss options. After being directed to an income review process, Reina found it was not so easy. The program knew that Reina’s income had increased, but not by how much. 

A formal income review would take some time.

Meanwhile, Reina’s pharmacist was demanding payment and, to make matters worse, some of her new medication was not covered at all – it fell into an excluded range of drugs only covered when a doctor receives a “special authority” approval from the program. Reina’s doctor did not have it. Desperate for her medication, Reina contacted us.

We agreed to investigate and quickly contacted the program inquiring about a possible interim solution. Reina needed time to both file her back taxes and complete the income review process. The program agreed, temporarily extending Reina’s coverage based on a notarized affidavit – signed by Reina – demonstrating her low income. 

For the special authority program approval, PharmaCare committed to review their publicly available information and develop new public awareness strategies to inform clients like Reina of the coverage protocol. 

When we followed up, Reina said she was pleased that her complaint led to enhanced service for others. Reina had received the coverage she needed and PharmaCare was improving its communications.

Names in our case summaries have been changed to protect the privacy of individuals. This case study can also be found in the 2016-2017 Annual Report.

Category Seniors
Type Case Summary
Fiscal Year 2016
Location Vancouver Island / Sunshine Coast