Insurance

The information related to the operational procedures that patients have to follow to access the insured services is provided below. First of all, it should be kept in mind that services may be guaranteed through two benefit schemes:

a) Direct health care: patients are given the option of accessing the health services supplied by the facilities that have an agreement with the insurance, with direct payment to the facilities in possession of said agreement of the amount due for the service received by the patient, who therefore does not have to pay any amount in advance, with the exception of any deductibles and/or uncovered charges and amounts exceeding any rate limits provided for, which remain his/her responsibility; if the patient is authorised to receive a service at a facility that has an agreement with the insurance, but the medical team is not (so-called Mixed Services), with reference to the fees of the team not in possession of an agreement, the insurance, if this regime is covered by its Health Plan, will pay according to the method indicated in point b), always within any rate limits and conditions provided for by the reference option.

b) Indirect health care: patients are reimbursed for expenses sustained for the services received at the health facility. Upon discharge, patients must settle invoices and bills of costs and, to obtain the reimbursement, against specific request by the insurance, they must show adequate documental proof of payment of the health service for which reimbursement is requested.

Before hospitalisation or undergoing surgery, patients have to contact the Telephone Exchange beforehand - through the phone numbers indicated in the policy, to receive authorisation from them to benefit from the service in direct or mixed health care regime.

Authorisation should be requested from the Telephone Exchange with 48 working hours advance notice. It remains understood that the Telephone Exchange should receive the request with adequate advance notice, in relation to the specific type of service/intervention requested.

• Surname and name of the person who must perform the service;
• Telephone number of the person who must perform the service;
• Date of the service.

• Prescription for the service to be performed
• Diagnosis
• Medical certificate certifying the hospital service to be performed
• The Emergency Room medical report, in case of accident, as it will have to be objectively documentable.

The authorisation will be issued to the patient by the Telephone Exchange in the terms and limits provided for by the Health Plan only if the administrative and medical-insurance checks of the request put forward are positively passed.

Please contact us for any further information