What is the Approved Provider Network (APN)?
Your plan sponsor has opted to participate in an Approved Provider Network (APN) for their employee benefit plan. The APN is a network of providers that have gone through a vetting process and represent quality and ethical business practices.
What benefits under my plan does the APN apply to?
There are currently five different types of medical supplies that must be purchased through the APN approved providers if you are seeking reimbursement under your employee benefits plan:
- Compression Hosiery
- Custom-Made Orthotics
- Orthopaedic Footwear and Modifications
- Medical Braces
- TENS Machines
If you or one of your eligible dependents requires one or more of the above items, you will need to purchase it through one of the Approved Providers.
Who are the Approved Providers?
You can locate a provider near you using the search tool on the APN website. Additionally, you may also purchase any of the above supplies (if available) at an Ontario hospital.
Is using an Approved Provider mandatory? What if I don’t want to use one the Approved Providers to purchase my supplies?
In order to have your claims for the specified medical equipment paid through your insurance benefits, the supplies must be purchased from one of the Approved Providers listed on this website. Should you choose to purchase any of the specified supplies from a non-approved provider, your claim will not be reimbursed through your employee benefit plan.
When does the APN become effective?
The APN was implemented on November 1, 2019. However, your plan sponsor may have chosen to make the APN effective for your benefit plan on a different (later) date. Your plan sponsor can confirm the date that the APN is effective for your benefits plan.
Where can I find an Approved Provider near me?
A list of all the Approved Providers and their locations is available on the APN website. The website features a search tool that can be used to locate a provider near you.
What happens if I am unable to attend an Approved Provider?
There may be some circumstances that prevent you or your eligible dependant from attending an approved provider. In these circumstances, it is recommended that you contact your plan administrator to confirm what options are available. Policies may vary between plan sponsors.
I purchased one of the specified products from a non-approved provider before the APN became effective, will it be accepted?
Yes. Any claims for expenses incurred prior to the date your plan became effective with the APN will be honoured, regardless of when they are received by the insurer. However, these claims must still be received within the claim submission timeframe specified by your plan and will be assessed according to your benefit plan allowance.
I purchased one of the specified products from a non-approved provider after the APN became effective, will it be accepted?
No. Your benefit plan will not reimburse you for the expense once the APN is effective if you purchased it from a non-approved provider.
Do I have to go to a specific doctor for my prescription?
No. There is no requirement for you or your eligible dependant(s) to attend a specific physician or prescriber. However, the prescriber you do attend must still meet the qualification requirements of your benefit plan. Refer to your benefit booklet for further information on these requirements. Additionally, you may also contact your insurance company for coverage inquiries.
I have feedback or concerns regarding an Approved Provider, where can I report this information?
There are multiple ways you can submit feedback or concerns, including service issues or unethical behaviour:
- Report through the APN website here
Will the APN affect or change my benefit coverage?
No. Participation in the APN does not change your benefit plan coverage. It only affects where you can purchase the specified supplies.
Where can I find details of my benefits coverage?
For coverage inquiries or claim requirements specific to your benefits policy, please consult your benefit booklet that was provided to you by your plan sponsor. Alternatively, you can contact your insurance company for information as well.
How do I submit my claim(s) from the Approved Provider to the insurance company for reimbursement?
You can continue to submit claims as you normally would to your insurer, this process is not changing. If you are unsure how to go about submitting a claim, please contact your insurance company directly.
I don’t live near an Approved Provider. What are my options?
While there are many options for Approved Providers within the GTA, it is possible that some people may live more remotely and not be able to access an APN provider. In these circumstances, it is recommended that you contact your plan administrator to confirm what options are available. Policies may vary between plan sponsors.
My spouse has a benefit plan through a different employer that does not participate in the APN. Will this change how our claims are coordinated?
No. Your claims will continue to be coordinated as they always have. However, regardless of whether your plan is the primary or secondary payer, claims for you or your eligible dependants from non-approved providers will not be reimbursed under your plan once the APN is effective.
None of the Approved Providers have the specific product I want or need. What do I do?
While the Approved Providers have a wide variety of product brands and styles that can accommodate most requirements, it is possible they do not carry every single product. It is recommended that you contact the Approved Provider directly to confirm if they have anything comparable, or if they are able to do a custom order for the product you are looking for.
You may also contact our APN team for further assistance.
Can my current provider apply to be part of the APN?
Yes. Interested providers can submit an inquiry through the APN website:
www.healthcareapn.ca/provider-inquiry.
Please note: The application process for new providers can take up to three months and approval is not guaranteed. Therefore, if you are in need of any of the medical equipment or supplies listed under the APN, please refer to the APN website to find an Approved Provider in your area.