Standard Operating Procedure

Table of Contents 

• Medical Expenses
• Out of Pocket Expenses

Medical Expenses (top)

1. In consultation with a gastroenterologist or any of the other specialties of physician which appears on Tran 2 / Hemo 2, the Administrator shall compile a list of medications/treatments which are recommended/prescribed for persons who have HCV and for conditions due to infection with HCV or treatment of HCV and which are generally accepted by the medical community (the "HCV Medication List"). This list shall be periodically updated at the Administrator's discretion.
2. The Administrator may accept a completed Gen 3 accompanied by receipts as proof of medical expenses for any of the items on the HCV Medication List, except where:

1. the total claimed on any one application exceeds $500 (to be discussed) excluding the costs of HCV Compensable Therapy;
2. the level of medical expenses claimed is inconsistent with the HCV Infected Person's overall application or disease level (e.g.: a person who is at Level 1 and has a negative PCR test claiming for significant medical expenses); or
3. for any other reason the Administrator suspects the claim is not valid and wants the backup of a physician confirming the medications were prescribed or recommended.

3. Where reimbursement is claimed items which are not on the HCV Medication List, where one of the exceptions described above applies, or where there are items for which a claim is made but no receipts are available, the Administrator shall:

1. require the HCV Infected Person to supply a form completed by a treating physician confirming that he or she recommended the claimed items; and/or
2. at the Administrator's discretion, consult a treating physician of the appropriate speciality to advise whether the items are generally accepted by the medical community.

Out of Pocket Expenses (top)

4. The Administrator may accept a completed Gen 3 accompanied by receipts (for those items which should be the subject of a receipt) as proof of out of pocket expenses due HCV infection, except where:

1. the total claimed on any one application exceeds $500 (to be discussed);
2. the level of expenses claimed is inconsistent with the HCV Infected Persons overall application or disease level (e.g.: a person who lives in a major centre claiming travel costs to doctors appointments or a person who is at Level 1 and has a negative PCR test claiming for frequent appointments with doctors); or
3. for any other reason the Administrator suspects the claim is not valid and wants the backup of a physician confirming the expenses were incurred.

The maximum paid for expenses which are covered by the Treasury Board of Canada Secretariat Travel Directive shall be the amounts stipulated in the Treasury Board of Canada Secretariat Travel Directive.

5. Where one of the exceptions described above applies or where there are items claimed for which the HCV Infected Person does not have receipts but should have a receipt, the Administrator shall:

1. require the HCV Infected Person to supply a form completed by a treating physician confirming that the HCV Infected Person had to incur the expense in order to seek medical advice or treatment for infection with HCV;
2. in the event that item for which reimbursement claimed is such that it is not amenable to confirmation by the treating physician, seek such additional evidence as the Administrator considers appropriate.

6. With respect to compensation for forms which must be completed by a treating physician in order to obtain compensation, the Administrator shall have regard to the BCMA position on reasonable fees as stipulated in the letter from the BCMA dated June 15, 2000.
   
   
   
   
   Disclaimer

   This Standard Operating Procedure is intended to assist the reader with respect to the subject matter and the procedures set forth in this Standard Operating Procedure, however, in the event there is any difference or ambiguity between this Standard Operating Procedure and the 1986-1990 Hepatitis C Settlement Agreement such difference or ambiguity will be governed by and will be resolved by the terms of the 1986-1990 Hepatitis Settlement Agreement.