ISSUE: Up against a rapidly closing treatment window, a Veteran reached out after Veterans Affairs Canada (VAC) denied her application and appeal for fertility treatment cost coverage. An OVO Issues Analyst reviewed the case and discovered that VAC had mistakenly considered the application under the wrong coverage category.
VAC coverage for medications and treatments varies based on the Veteran’s disability entitled conditions and their coverage category. Broadly defined, A-line coverage category requires a link to an entitled condition, and B-line coverage category does not require a link to an entitled condition but generally only includes medications and other treatment not covered through provincial or private health care insurance. In this case, the treatment was initially denied because it was considered under A-line coverage and the condition had no established link to service on file.
ACTION: Once the OVO had identified the error and notified VAC, VAC requested additional medical documentation from the Veteran and reconsidered the authorization under B-line coverage. At the time, VAC was working to implement infertility treatment as an approved benefit as recommended by VAC’s internal review committee. After considering all the evidence, VAC decided to cover nearly all of the Veteran’s treatment costs; this was welcome news for the Veteran, who had already paid for the treatments.
RESULT: VAC corrected its error and reimbursed the Veteran for most of the treatment costs she had incurred. However, had she waited for approval or been unable to even temporarily cover the expenses, it would have been too late to receive the time-sensitive treatment.