Stage 2 - Administrative Review by Medical Services Branch
If the decision made by MSB is to deny the application for funding, the beneficiary may request an administrative review of the denial. To request the administrative review, the beneficiary must supply MSB with additional relevant information from the appropriate specialist.
The request for an administrative review must be made by the beneficiary within six months after the date of the initial determination made by MSB under Stage 1 (above). If the request for administrative review is not made within six months, the administrative review will not take place.
The beneficiary will be notified of the decision resulting from the administrative review in writing.
Stage 3 - Formal Review by Medical Services Commission
If, after the administrative review is concluded, the application for funding is denied again, the beneficiary may request that the MSC formally review the decision of MSB. The question for the MSC to determine in the formal review is whether MSB properly applied the Out of Province and Out of Country Medical Care Guidelines for Funding Approval.
The formal review is conducted by an MSC Review Panel, which consists of three members -- one representative from each of the Ministry of Health Services, the British Columbia Medical Association and the general public.
The following guidelines apply to the MSC formal review process:
Beneficiaries may request an MSC Review Panel hearing only after an application for coverage has been through the regular application process and an administrative review has been completed by MSB.
The request for a formal review by the MSC of the administrative review decision must be made by the beneficiary within six months after the date of the administrative review decision. If the request for the formal review is not made within six months, a formal review will not take place.
Incomplete out of country funding applications and applications that are deemed abandoned by MSB are not eligible for review by the MSC Review Panel.
MSC Review Panel hearings may be conducted through written submission, teleconference (depending on location) or in person. Travel, accommodation and other ancillary costs such as legal fees are the responsibility of the beneficiary or his or her legal representative.
The MSC Review Panel will notify MSB and the beneficiary of their decision within 90 working days of the hearing unless otherwise agreed to by both parties.
Medical Services Commission Out of Country Funding Guidelines January 19, 2011