Steps to follow when you are using both PRIVATE/ WORKPLACE INSURANCE AND TRILLIUM DRUG PROGRAM COMBINED in cases where the insurance portion must be submitted manually to the insurer without an e-card:
Fill the prescription at the pharmacy. Make a xerox copy of the original receipt. This photocopy is Item A. Note that this receipt contains the name of the medication(s) and the costs. TDP does not need the cash or credit card receipt. Put your name and OHIP number or TDP registration (RA) number on each piece of paper or document that you send to TDP. Remember where you put Item A while waiting for Item B (below).
Send the original receipt, NOT Item A, to the insurance company. They will reimburse you the portion that they cover, usually 80% or 90%. Make sure that the physician on the receipt is registered under Facilitated Access if the drug is in that category.
You will receive a statement from the insurance company, along with your reimbursement payment. The original statement is Item B. Make a xerox copy for your records. The insurance statement should state clearly the name of the medications or the drug identification number. If it does not contain that information, TDP will likely request it. This will cause further delay. For each drug receipt copy, the drug information on the insurance statement should correspond. If the insurance does not cover one or more drugs, that will be listed on the statement. In that case, TDP may request an additional letter from the insurer, verifying the claim rejection. You may have to obtain this letter from the insurer.
Send Item A and Item B to Trillium Drug Program. TDP will credit your expense towards the deductible. They will reimburse you any amount that exceeds your quarterly deductible.
Even though you have private insurance, TDP fully covers your medications after you reach your deductible in any given quarter. If you submit your claims quickly, chances are the pharmacy computer will register this prior to your subsequent refills within that quarter. If there is a delay, you will likely need to use the private insurance later in the quarter, until TDP revises the computer system information after they process your claims.
Note: Reimbursement from Trillium Drug Program usually takes some time. Whether you accumulate your receipts and send them in batches to TDP, or whether you send them each time you fill medications depends on your financial situation. It also depends on your desire to reach your deductible sooner in a given quarter in order to have TDP cover the costs. If possible, try to create a financial ‘cushion’ for yourself before you begin these reimbursement procedures.
For an example of a sample letter for submitting your claims to TDP, see the sample letter in Appendix 1 on the previous page. For the main text statement, substitute:
“Please find enclosed my original insurance coverage statement(s) along with photocopies of the original pharmacy medication receipts.”