We know that it can be stressful asking your insurer to accept funding for your medication, so we want to do what we can to make this process straight forward!
Part of the work we do here at eCS Clinic is to apply on your behalf to your insurer and ask that
they pay for your medication. To do this, we need your help.
Firstly, the insurers we can apply to are WorkCover insurers (EML, Gallagher Bassett, Allianz, etc.), the the Transport Accident Commission (TAC), or to the Department of Veteran’s Affairs (DVA) if you are a card holder. We are unable to apply for funding from any private insurers, but we can provide you with a letter to pass on to them.
We have set out below the steps towards an application being made. Your Patient Advocate
(PA) are always here to help guide you through the process as well:
Part of the service we provide to our patients includes applying for funding from compensable insurers on behalf of our patients.
The insurers we can apply to are WorkCover insurers (EML, Gallagher Bassett, Allianz, etc.), the Transport Accident Commission (TAC), or to the Department of Veteran’s Affairs (DVA) if the patient is a card holder. We are unable to apply for funding from any private insurers, but we can provide patients with a clinical justification letter to pass on to the insurer themselves.
Advise the Medical Assistant (MA) in consultations that you wish to apply for funding. Provide your MA with accurate contact details, i.e. email address. After the consultation, you will receive an email asking for your insurer details. Please fill out the form to the best of your ability.
What you need to do:
- Advise the Medical Assistant (MA) in consultations that you wish to apply for funding.
- Provide your MA with accurate contact details, i.e. email address.
- After the consultation, you will receive an email asking for your insurer details. Please fill out the form to the best of your ability.
What we will be doing:
- Your Medical Practitioner (MP) will collect comprehensive notes at first consult.
- The MP will write a patient history in your file for future reference.
- The Patient Advocate (PA) team will receive an email with your completed insurer form.
- Your PA will write a clinical justification letter and collect supporting research and literature.
- Your PA will email this information to the insurer. Where possible, they will also email the appropriate case manager to get you a result sooner.
- Your PA will reach out to you regarding any progress made with compensation.
- The PA team will also apply for all required permits.
Compensable Patient Factsheet for DVA
Actions for Patients:
- Advise medical assistant in consultations that you wish to contact your desired insurer
- Provide your medical assistant with accurate contact details, i.e. email address
- You will receive an email asking for your insurer details. Please fill out the form to the best of your ability
- As soon as your form is returned to us our PAs will apply for funding and will remain in contact with you as progress is made
Actions During Your Medical Consultation:
- Your doctor will collect comprehensive notes at first consult. Accuracy of your medical condition is a key part to successful compensation
- You will be asked whether you have previously applied and received approval for funding
- The doctor will write a patient history in your file for future reference
- You will be assessed for current risk of substance use disorder, and low risk for substance use disorder
- PAs will be informed when your appointment is complete, will send a letter to your insurer and advise MPs of any additional information requested
- Our PAs will let the pharmacy know when all relevant approvals have been received. The pharmacy will then be in touch to dispense your medication
Pathway Post-Consultation:
If you have previously received approval:
- eCS Clinic requires a copy of the current TGA approval for the product
- eCS Clinic requires a copy of the relevant approval from State or Territory for the product
- With the above information, a Clinical Justification letter will be created
- An ongoing monitoring of your mental health status will ensue
If you have not previously received approval:
- A Clinical Justification letter will be created
- eCS Clinic requires a copy of the current TGA approval for the product
- eCS Clinic requires a copy of the relevant approval from State or Territory for the product
- Details of first line treatments for the condition and their results will be provided
- Several high quality studies supporting the efficacy and safety of the treatment for the condition will be provided
- eCS will require a written assessment from the treating specialist (pain specialist) that:
- Medicinal cannabis would clinically benefit you
- The dosing regimen that has been determined by clinical need
- You have been advised of potential contra-indications
- A suicide and mental health assessment has been undertaken and documented, determining there is no increased risk from medicinal cannabis on suicide ideation or mental health
- You have no current substance use disorder, and have low risk for substance use disorder
To begin your journey with eCS Clinic, you can book you free consultation online or book your free consultation via phone on (03) 9117 9000.
If you have any questions about the information in this factsheet or about anything else.
