About Appeals
If you have been denied coverage for an item, service, or travel, you have the right to appeal the decision. You can submit an appeal up to 12 months from the date that your benefit was denied. Appeals can be submitted by the client, their parent or guardian, or a representative.
Call Health Benefits at 1-855-550-5454 to learn more about the appeals process.
How to Submit an Appeal
Once you have spoken to Health Benefits and are ready to appeal a decision, write a formal letter that describes the situation in detail, including the following information:
- the diagnosis of your medical condition
- the prognosis, or expected outcome, of your medical condition, including what treatments have been tried
- justification for the proposed treatment
- any additional supporting information
Your appeal also needs to include relevant documentation, such as:
- a note from your doctor or health care provider explaining your condition and need for the item, service, or travel
- diagnostic results (e.g. dental x-rays, blood test results)
Once you are ready, please mail your appeal to:
FNHA Health Benefits Program
#540 – 757 West Hastings Street
Vancouver, BC V6C 1A1
Orthodontic Appeals
To appeal orthodontic coverage, please include the following information with your formal letter. You can get this information from your dentist or orthodontist.
- orthodontic summary form, with HLD index results
- diagnostic test results, including:
- cephalometric radiographs with associated scale for calibration
- frontal and profile photographs
- intra-oral photographs depicting the right, left, and anterior occlusal relationships
- panoramic radiographs
Please mail orthodontic appeals to:
Pacific Blue Cross
PO Box 7000
Vancouver, BC V6B 4E1
