Patient Reimbursement

How to determine coverage for Reviscon® Mono 2.0%

Follow this guide to verify eligibility under your insurance plan, capture the pseudo product identification number (PIN), and prepare a complete claim for Reviscon® Mono 2.0% viscosupplementation.

View the 3-step checklist Jump to insurer PINs
1

Check your insurance plan

Review your benefits booklet to confirm whether Reviscon® Mono 2.0% qualifies for reimbursement. Focus on these sections:

  • Health Care Spending Account (HCSA/HSA)
  • Extended Health Care Benefits
  • Medical Supplies and Services
  • Supplementary Health
  • Prescription Drugs
2

Review your coverage carefully

Look for details that affect reimbursement before you schedule treatment.

  • Viscosupplements are typically covered under extended healthcare benefits. Insurers typically require the submission of a completed health claim form for eligibility review. In certain cases, a supporting letter or medical note from the prescribing physician, detailing the diagnosis and clinical indication for treatment, may also be requested.
  • Confirm whether your plan includes annual or lifetime maximums for viscosupplementation.
  • Check for limits on how many injections can be reimbursed within a year or treatment cycle.
  • Clarify if the treatment must be prescribed by a physician or specifically by a specialist (e.g., an orthopaedic surgeon).
3

Submit a complete claim

Prepare your paperwork using the terminology insurers expect to see.

  • Submit the original receipt together with the completed health claim form.
  • Double-check every section of the form to avoid processing delays.
  • Reference terminology such as "Viscosupplement" or "Hyaluronic Acid Injection," list the product name Reviscon® Mono 2.0%, and include the pseudo product identification number (PIN).

Pseudo product identification numbers

PINs and notes by insurer

Provide the insurer name and the corresponding pseudo product identification number (PIN) when submitting your claim. Follow any special instructions noted for specific providers.

Insurance company (adjudicator)* PIN for claim submission
Assumption Vie 90109359
Beneva Insurance / La Capitale ----
Canada Life 90109359
ClaimSecure Inc. 90109359
Empire Life 90109359
Express Scripts Canada (Industrial Alliance, Managed Health Care Services Inc. (MHCSI), Manulife Financial) 90109359
Equitable Life Insurance of Canada 90109359
Green Shield Canada 90109359
Manitoba Blue Cross No electronic payment. Pay first and follow the process for submitting a claim.
Medavie Blue Cross 90109359
NexGenRx ----
OTIP RAEO 90109359
Pacific Blue Cross 90109359
Saskatchewan Blue Cross No electronic payment. Pay first and follow the process for submitting a claim.
SSQ Financial 90109359
TELUS (Great West Life, Desjardins Financial, Sun Life Financial) 90109359

*Your insurance provider may not be listed. Contact your insurer directly to confirm eligibility and coverage details for Reviscon® Mono 2.0%.

If the treatment is not covered

Advocate for an exception or additional review by working through the following escalation path:

  • Contact the insurance provider's benefits department to confirm whether viscosupplementation or hyaluronic acid injections are excluded and request a written explanation.
  • Inform your human resources (HR) department that your physician has prescribed Reviscon® Mono 2.0% and share the insurer's response.
  • Ask your HR department to follow up with the insurer for clarification or an exception.
  • Determine whether the lack of coverage is a plan-level exclusion chosen by your employer or a policy decision by the insurer.
  • If employer-related, request a case-by-case exception for this medically necessary treatment.
  • If insurer-related, ask your physician to submit a letter of appeal explaining the medical necessity.
  • If the appeal is denied, file a formal complaint with the insurer and request a reconsideration of the decision.