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HOW IS THE REIMBURSEMENT CHARGED WITH THE INSURERS?

There are two ways to make a claim payment: by reimbursement and by direct payment. In the case of a reimbursement, the doctor can speak directly with the patient and issue an invoice for the value of his services. The patient will make the payment to the doctor and later, with the bill, they can recover the money they paid their doctor directly from the insurer.

IMPORTANT TO COLLECT REFUND

In order for a patient to be able to collect reimbursement, it will always be important that they have all the documents (laboratory studies, medical prescriptions, bills in the name of the patient and a medical opinion), which must be presented to the insurer to make the reimbursement of their bills.

In the case of direct payment, the insurer is responsible for paying the hospital and the medical team directly through the medical report issued by the treating physician or surgeon.

WHAT IS THE PROCESS FOR CHARGING A REFUND?

The process to receive a reimbursement from any insurance company is as follows:

  • Once the patient submits their documentation, the insurer reviews the information, the medical tests, and the diagnosis, that the medical report is consistent with the treatment, the bills, and that the medications are consistent with the diagnosis that appears in the patient’s statement medical.
  • For a claim to proceed, the insurer verifies that it does not have “waiting periods” (Minimum time of uninterrupted coverage that must elapse after the date of discharge of the insured, does not apply in the case of an accident or medical emergency), that there are no statements on the application and containing all medical history.

DETAILS IN THE MEDICAL EXPENSES INSURANCE POLICIES

The Medical Expenses Insurance policies contain tables or tabulators to make the adjustment and a limit of medical fees for hospitals.

It is important that the fees coincide with the amounts establish for the hospital where the insure was treat, in the event that they were treat in a lower level hospital, they will obtain incentives, on the other hand there are penalties from the insurer if they do not match the hospital level establish in the policy with the place where you receive care.

Consult your insurer to verify the specific requirements if you are a patient who wishes to make a reimbursement, and if you are a doctor, do not forget that you can consult us whenever you want to learn more about the administrative processes of the medical practice. At Pagomed we are here to advise you.

TAKE OUT MEDICAL EXPENSE INSURANCE THAT SUPPORT YOUR

When we or a family member gets sick, it is not only health that suffers, but also the family economy. No matter how mild the condition, the costs of a day of hospitalization or surgery can be very high. Have you thought about what you would do if you were involved in such a situation?

Every day we are expose to some mishap, for this reason, prevention will always be the most important thing to protect the well-being of our family and economy. It is essential to have the necessary preventive measures to avoid that, in the event of any mishap, we find ourselves in the need to cover expenses that we had not contemplated and that for many people would be impossible to absorb, the best way to do it is through the support that offers Major Medical Expenses Insurance.

The Major Medical Expenses Insurance is focus on covering illnesses and diseases that impact or seriously threaten the economic and patrimonial stability of any person, those illnesses whose expense would be equal to or greater than the policy deductible.

In addition, a major medical expense policy absorbs the expenses generated from:

  • Medical fees
  • Hospitalization
  • Ambulance
  • Medicines

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