Medication coverage denial

DonnieD wrote:So I got medical marijuana prescribed last year for conditions I live with everyday since service. However, VAC denied my claim and I've been having problems since. Now mentally I am in a terrible spot so I'm not as confrontational as I was when I was younger however, this is starting to disrupt with my life as I can't buy more than half of the prescription each month due to the ridiculous costs. So VAC denied my medication coverage even though I use it for what they caused.
What are my options? I never appealed it because I assumed it would just get denied like most appeals. Is my only option to take legal action? I know I can win 100% it's just like I said, mentally I don't think I can take the whole legal process. So what the hell should I do as conventional drugs never worked for me so I went drug free for 5 years living in pain until I found out about marijuana which gives me relief. I'm lost, I tried calling the legion for advice but they were clueless.

Donnie,

They must have given you a reason why they refused the claim, this is where you decide what your next move will be.

Look at the Eligibility here:

Veterans entitled to a Veterans Affairs Canada Disability Pension and/or Disability Award are eligible for the cost of treatment in respect of their pensioned/awarded condition (see Treatment in Respect of a Pensioned or Awarded Condition Policy): http://www.veterans.gc.ca/eng/about-us/policy/document/1915 Certain Veterans may also be eligible for the cost of treatment for non-pensioned/awarded conditions to the extent the treatment is not available from the province/territory in which they reside (see Eligibility for Health Care Programs – Eligible Client Groups): http://www.veterans.gc.ca/eng/about-us/policy/document/1020

Look at the Policy here:

- Veterans Affairs Canada may reimburse an eligible Veteran for the costs of cannabis for medical purposes, when the health care practitioner’s (defined in Health Canada’s Access to Cannabis for Medical Purposes Regulations as a medical practitioner or a nurse practitioner) authorization is in accordance with Health Canada’s Access to Cannabis for Medical Purposes Regulations. The authorization document completed by the health care practitioner indicates the amount of grams per day of dried marihuana.

- Veterans Affairs Canada, requires the following documents to confirm the Veteran meets the requirements of Health Canada’s Access to Cannabis for Medical Purposes Regulations for the purposes of determining entitlement for reimbursement:
a. copy of the authorization document completed by the health care practitioner; and,
b. copy of the completed and confirmed registration document with a licensed producer.

- Veterans Affairs Canada will only accept authorization from one health care practitioner at a time. More than one authorization may be considered, but the authorizations must be from the same health care practitioner.

- Eligible forms of cannabis include all forms that are authorized by section 3(1) of Health Canada’s Access to Cannabis for Medical Purposes Regulations for sale by licensed producers (with the exception of seeds and plants). Currently, licensed producers may produce and sell dried and fresh marihuana, and cannabis oil.

- The maximum daily Veterans Affairs Canada reimbursement limit is 3 grams per day of dried marihuana (or the equivalent in other eligible forms).

- Requests for reimbursement for more than 3 grams of dried marihuana (or the equivalent in other eligible forms), will require additional information for consideration as set out in Annex A. This applies to those being reimbursed for more than 3 grams per day on the coming into force of this policy, and all new requests.

- Veterans being reimbursed for cannabis for medical purposes on the release date of this policy may continue to be reimbursed at their current level for six months.

- Veterans Affairs Canada will reimburse the Veteran based on a fixed rate per gram of marihuana, when authorized in its dried or fresh form or the same fixed rate per gram equivalent in cannabis oil. In other words, Veterans Affairs Canada will reimburse the Veteran at a fixed rate per gram whether taken in fresh or dried marihuana, or the equivalent in cannabis oil.

- Veterans Affairs Canada does not reimburse the cost of cannabis for medical purposes when the Veteran purchases cannabis outside Canada. The legislative regime established by Health Canada for access to cannabis for medical purposes includes regulatory requirements for the safe production and distribution of cannabis, and for legal possession. Recognizing the complexity and variety of approaches internationally, the Department is not able to adequately ensure the same level of regulatory oversight for the safe production, authorization, distribution, and legalization of cannabis for medical purposes. The health and well-being of Canada’s Veterans is paramount, and the varied approaches to cannabis for medical purposes is of concern

- Veterans Affairs Canada only reimburses the cost of cannabis for medical purposes when the product is purchased from a licensed producer (with the exception of seeds and plants). Canada has established a regulated system of licensed producers that ensures producers are meeting standards for quality and safety. This standardization is an essential consideration when determining whether to reimburse Veterans for cannabis for medical purposes. The health and well-being of Veterans is best ensured through accessing cannabis produced by the licensed producers authorized in accordance with Health Canada’s Access to Cannabis for Medical Purposes Regulations.

- No fee is paid to the physician for the completion of the authorization document since VAC considers it to be covered in insured service fees. However, if the Department requires the health practitioner to complete additional documentation, an administrative fee may be paid.

- Veterans Affairs Canada may deny approval of reimbursement when licensed producers are determined to be operating outside of the requirements of Health Canada’s Access to Cannabis for Medical Purposes Regulations, the requirements of this policy, and/or any approved provider criteria established by the Department and agreed to by the licensed producer.

- Reimbursement for the cost of the purchase of a vaporizer may be authorized for eligible Veterans up to the established dollar limit. The purchase must be pre-authorized, and prescribed by a health practitioner. Veterans Affairs Canada may consider other “equipment” when the device is medically beneficial, subject to the provisions of the Medical Supplies policy.

http://www.veterans.gc.ca/eng/about-us/policy/document/2461

After looking over the Eligibility and the Policy, if you find evidence that proves you should be covered by VAC, then you can use this for your appeal. Also, before you appeal you can contact a CM in your area explaining why it is you feel you should be covered.

You can find How to Appeal a Health Care Decision, here:

http://www.veterans.gc.ca/eng/services/health/treatment-benefits/tb-appeal

So I got medical marijuana prescribed last year for conditions I live with everyday since service. However, VAC denied my claim and I've been having problems since. Now mentally I am in a terrible spot so I'm not as confrontational as I was when I was younger however, this is starting to disrupt with my life as I can't buy more than half of the prescription each month due to the ridiculous costs. So VAC denied my medication coverage even though I use it for what they caused.
What are my options? I never appealed it because I assumed it would just get denied like most appeals. Is my only option to take legal action? I know I can win 100% it's just like I said, mentally I don't think I can take the whole legal process. So what the hell should I do as conventional drugs never worked for me so I went drug free for 5 years living in pain until I found out about marijuana which gives me relief. I'm lost, I tried calling the legion for advice but they were clueless.