The program can approve funding for tests not available in B.C. when there is sufficient evidence that the test is medically necessary and will change active patient management. The completed application form must clearly demonstrate the medical need for the requested test. Include additional evidence in the form of a medical consult note, previous in-province tests, or other relevant information, with the application. We make each funding decision on a case-by-case basis, without precedent, based on the specific patient presentation and/or clinical indication.
The program does not fund tests managed and funded by a specific provincial program, fee-for-service laboratory testing, or for tests covered by health authority global funding (including lab tests associated with most acute care services).
All relevant in-province testing must be completed before submitting a funding application.
Funding criteria
The program can approve funding for tests not available in B.C. when:- the tests are medically necessary
- the results will create a new medical treatment plan
- the results will significantly alter current active treatment for the patient
- the patient is an MSP beneficiary, i.e. having an active Personal Health Number (PHN)
- the ordering practitioner is a physician assigned a BC Ministry of Health MSP billing code, and
- practicing in a specialty that is relevant to the request
The program does not fund:- tests which are not standard of care and cannot change patient treatment
- tests which do not significantly alter active treatment of the patient's condition
- test which are experimental or developmental with unknown/unproven efficacy
- tests which are required for clinical trials
- tests without regulatory approval
- tests performed in labs lacking appropriate accreditation and or regulatory approval
- testing required for workplace monitoring
- testing required for insurance benefits
- predictive/lifestyle/executive/personalized testing
- testing without completion of all appropriate in-province testing and consultations
- testing used to monitor compliance
Patient eligibility
The beneficiary must have an active B.C. personal health number (PHN) at the time of the application and at the time of service.
The OOP program has no ability to reimburse a requesting practitioner, patient, or health authority for any services.
Patient consent
Practitioners are expected to discuss informed consent for out-of-province testing with the patient. Upon understanding how their personal information will be handled by the OOP program, the patient or the patient's parent or legal representative (if 13 years old or under) must complete the consent form. Applications cannot be processed without patient consent.Patients can complete the Consent Form via an online portal.
Application form
A thoroughly completed application makes it more likely that a decision can be reached quickly.
Incomplete applications or applications lacking sufficient information will either be cancelled or denied describing the missing information.
Practitioners can complete the Genetic Application Form or the Non-genetic Application Form via an online portal.
Expedited reviews
Application reviews and decisions typically are completed within 2-3 business days.Genetic applications requesting additional funding for expedited testing qualify for RAPID review when:
- the patient is either acutely ill (i.e., admitted to the hospital) AND deteriorating rapidly or,
- the patient is currently pregnant
An expired approval letter is not cause for rapid review.
Information to submit
- A completed comprehensive application form per patient. Genetic and non-genetic tests require different application forms.
- A completed patient consent form.
- All additional supporting information, including results of all relevant in-province tests, or a medical consult note.
Application status
Once the program reviews the funding application and reaches a decision, a decision letter will be faxed to the fax number provided by the requesting practitioner. The decision letter provides instructions to both the practitioner and patient on proceeding to sample collection.If you have not received a decision letter within the expected timeframe, contact the program at ooc@phsa.ca to ask for the status of your application. Please do not submit duplicate applications
Approval decision validity
Approvals are valid for 3 months which should allow for a sufficient time to coordinate the patient's specimen collection.
Due to billing and invoice limitations approvals cannot be extended.
Expired approvals
The program does not allow extensions for an expired approval letter.If a sample cannot be collected within 3 months of the date of approval, a new application must be submitted. The new application will be subject to the program's current guidelines at that time. We may request new information when you re-apply, based on how much time has passed since the last approval, or on evolving approval guidelines.
Only resubmit an application after the approval letter has expired. Provide the original application number, and indicate:
- that it is a resubmission, and
- that testing has not proceeded under the previous approval.
The program will not fund duplicate testing for the same patient, which may result in the patient or provider having to pay.
Cancelled applications
An application will be cancelled if:
- The patient's personal health number (PHN) is invalid or inactive at the time the application is submitted
- The patient consent form is not submitted
- Required documentation has not been submitted (e.g. consult note, previous test result, etc.)
- The application is illegible or incomplete
Denied applications
If the patient's presentation does not meet the funding guidelines or the application has not demonstrated how it meets the guidelines, funding will be denied. Refer to the Guidelines (PDF) for further details.
Incomplete or unclear applications may also be denied.
The reasons for denying funding will be provided in the decision letter. Please read the decision letter in its entirety.
Appeal process
An appeal references a denied application and MUST address the reasons for denial and may contain new information that was not available or provided at the time of the initial application.
Complete the Appeal/Change Application and FAX to 604-699-9718.
Appeal reviews require additional time to adjudicate and the program does not process appeals in the same timeframe as new applications.
The program could potentially deny appeals which do not address the reason for denial with no further comment. The program may place restrictions on the number of times an application can be appealed if the new information received still does not meet funding criteria.
Change request process
A change request references an approved application where a change to the approved test or approved referral laboratory is desired. A detailed explanation for the change must be provided.Complete the Appeal/Change Application and FAX to 604-699-9718.
Change reviews require additional time to adjudicate and the program does not process appeals in the same timeframe as new applications.
The program could potentially deny change requests depending on the change and the reason for it. If a change is denied the reason will be provided in the decision letter. The program may place restrictions on the number of times a decision can be changed if the change does not align with program criteria
An appeal references a denied application and MUST address the reasons for denial and may contain new information that was not available or provided at the time of the initial application.
Complete the Appeal/Change Application and FAX to 604-699-9718.
Appeal reviews require additional time to adjudicate and the program does not process appeals in the same timeframe as new applications.
The program could potentially deny appeals which do not address the reason for denial with no further comment. The program may place restrictions on the number of times an application can be appealed if the new information received still does not meet funding criteria.
OOP Appeal Change Application (PDF)
Instructions for patients
Instruct the patient to have their blood collected at a health authority outpatient laboratory or specimen collection centre. On the day of specimen collection, the patient must bring:- OOP/OOC Funding Approval letter indicating the test approved for funding and the address of the testing laboratory
- B.C. laboratory requisition (for specimen collection)
- Testing laboratory requisition and consent form, if appropriate
The specimen collection laboratory will collect the specimen(s) and send it to the testing laboratory. The patient must be aware and consent to their personal information and sample being sent to the testing laboratory outside the province.
Approved vendor laboratories
The program approves funding through accredited vendor partners (PDF) that meet quality requirements.
Program staff will need to evaluate requests for testing at a previously unvetted laboratory, to ensure they meet criteria and that the program is able to set up third-party billing. We can only approve testing after we have successfully added the laboratory as an approved vendor.
Test results
The laboratory will send the test result to the practitioner who requested the test, as indicated on the referral laboratory requisition. Referring practitioners should contact patients to discuss the test result and care management.The program does not provide copies of any test result.
The laboratory will send the test result to the practitioner who requested the test, as indicated on the B.C. laboratory requisition. Referring practitioners should contact patients to discuss the test result and care management.
The OOP program does not provide copies of any test result.
Vendor payment
The program is responsible for paying the vendor laboratory that performed the approved test(s) for the amount indicated on the funding decision letter.The letter includes instructions to the testing laboratory for billing.
Vendor laboratories should not send bills for approved OOP/OOC laboratory and genetic tests to the patients, referring practitioners, or hospital laboratories responsible for specimen collection and shipment. The program has no ability to reimburse those entities.
In the event a specimen has been sent for testing without program approval, the shipping laboratory or requesting practitioner is responsible for covering the cost of the testing.