Appealing cost-share and benefits

How to appeal cost-share status and benefits received

If you are not exempt from cost-sharing and feel that cost-sharing will cause you financial hardship, you can appeal your cost-sharing status using the Cost-Share Exemption Appeal notice form.

Appeals are heard by an independent committee of three private citizens called a Citizens' Appeal Panel. These panels are appointed by the government, but are not employees of the government. The panels have the power to make final decisions about your appeal. Their decisions are binding on both you and the Government of Alberta. While the panels are legal bodies, the appeal hearings are conducted in an informal manner.

Quantity and frequency review

A maximum number of each benefit is available each year. However, AADL will review requests for more than the maximum number (referred to as quantity and frequency).

Here are the steps for a Quantity and Frequency Review request:

  1. Your authorizer/specialty supplier must complete the Quantity and Frequency Review form and submit it within 20 days of your assessment.
  2. The Quantity and Frequency Review form is reviewed by the AADL program manager.
  3. If your request is denied by the AADL program manager, it can be referred to the Quantity and Frequency Review Committee (QFRC) at the request of your authorizer/specialty supplier.
  4. If your request is denied by the QFRC, it can be appealed to the AADL director. Either you or your authorizer/specialty supplier can make this final appeal to the director.

For more information on this process, please speak with your authorizer or specialty supplier, or contact AADL.