Mr. Speaker, I have a Return to Oral Question asked by the Member for Range Lake on March 5th, 2025, regarding Coverage Exemptions for Uninsured Medical Procedures. The Member asked if there anything a doctor can do to convince decision-makers that an exception or an appeal is warranted if a procedure is not insured.

There is a robust process in place to assess appeals or requests for exceptions related to services that are not considered an insured service.

From the Member's line of questioning, I gather that the process was initiated through a prior approval request however the outcome of the request did not satisfy the patient.

In accordance with the Medical Care Act and the Medical Care Regulations, the director of medical insurance designates a medical advisor, who is a physician, to review prior approval requests and make recommendations. Depending on the complexity of the case, the file is reviewed by the medical advisor and any additional Department of Health and Social Services staff or other clinicians within the territory and in consultation with the medical specialist or other experts from outside the NWT, as needed.

The review and recommendations of the medical advisor, based on clinical input and aligning with funding of medical services in other jurisdictions across Canada, are reviewed by the director of medical insurance and the decision of the director is final. Thank you, Mr. Speaker.