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Application/Bill Status Request Formulas FAX THIS REQUEST TO916.491.6459This form is to be used for requesting the status of applications or bills that have been submitted to the Victim Compensation

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What is request or formulary exception?

Request or formulary exception is a process where an individual can ask for special consideration for coverage of a specific medication, outside the standard formulary or coverage guidelines of an insurance plan.

Who is required to file request or formulary exception?

Any individual who needs a medication that is not covered by their insurance plan's formulary or coverage guidelines is required to file a request or formulary exception.

How to fill out request or formulary exception?

To fill out a request or formulary exception, the individual needs to provide information about the medication needed, reasons for the request, and any supporting documentation from a healthcare provider.

What is the purpose of request or formulary exception?

The purpose of request or formulary exception is to provide individuals with access to medications that are not typically covered by their insurance plan, but may be necessary for their health and well-being.

What information must be reported on request or formulary exception?

The information that must be reported on a request or formulary exception includes details about the medication, reasons for the request, and any relevant medical records or documentation.

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