Denied NIHB benefit: prepare the correct appeal level with relevant clinical information
Read the denial, confirm it is appealable, obtain provider support, sign and submit through the benefit-specific channel.
A service listed as an exclusion cannot be approved on appeal. A medical emergency must be handled by health services without waiting for administration.
Confirm the scope
Identify the client, benefit, original request, denial reason and completed level; distinguish denial, exclusion and incomplete reimbursement.
Prepare the information
Ask the prescriber or provider for diagnosis, prognosis, prior trials, rationale and new records suited to the benefit.
Complete the process
Write and sign the letter and file by secure account, mail or fax according to drugs, dental, equipment, vision, counselling or transportation.
Keep follow-up records
Keep delivery proof, answer missing-information requests and, if needed, move to levels two and three with new material.
Appealing an NIHB decision — Indigenous Services Canada