GUIDE FOR ADMISSION OF YOUR MEDICAL EXPENSE INSURANCE
Income with scheduled surgery or for medical treatment
Upon entering the Hospital, he / she shall present the original of the Authorization Letter of Programming of surgery or treatment, identification credential issued by the company and official identification with photograph as well as a payment deposit for personal expenses, deductibles, co-insurance and any other concept not covered by the company. A copy of the Program Authorization Letter must be submitted to your doctor.
Emergency Income and Hospital Report
When entering the Hospital through the Emergency area, prior to official identification with photograph, and in case the insured or beneficiary does not remain for more than 24 hours, the Hospital will provide the service and the insured or beneficiary will be required to pay directly To the Hospital the whole of the account, unless the company is responsible for the payment by Letter Authorization, applying the requirements set forth below.
When entering the Hospital through the Emergency area, if the insured or beneficiary stays more than 24 hours and requires hospitalization, he will present his identification credential issued by the company and official identification with photograph. It will provide all the information requested, as well as the payment of a deposit.
The Central Hospital of Medical Specialties will report by telephone to the company the income of the insured or beneficiary and will wait for a period of 24 hours the response of the same, which will be made known through an Authorization or Rejection Letter.
When the insured or beneficiary does not present any of the above documents or no response is received from the Company within 24 hours, the Hospital will provide the service and the insured or beneficiary will be responsible to pay directly to Central de Especialidades Médicas all of The account, unless before being discharged, the Hospital Letter Authorization is presented to the Hospital.
It is important that the insured or beneficiary is aware of the response of the company, so in the case of not obtaining it within the period stipulated above, it is suggested that the insured or beneficiary call directly to their Insurance Agent at the telephone number indicated In your policy.
Upon entering the Hospital, and in compliance with policies, the insured or their beneficiaries will be asked for a deposit, either with a credit card or cash, in order to guarantee the payment of personal expenses and services not included or not Covered by the company, such as: deductibles, coinsurance, difference in room, uncovered conditions, etc.
In the event that the insured or beneficiary elects his or her doctor and does not belong to the Network, it is important to consider that the company will pay according to the Medical Fee Chart of the contracted plan and the deductible and coinsurance agreed in its policy. It may happen that the doctor may charge differences in fees or that the payment of these fees can sometimes be carried out through reimbursement.
In the case of being attended by doctors of the Network, the medical fees will be covered according to the agreement, and there will be a decrease or elimination of the deductible and coinsurance, which will depend on the conditions of your policy, so it is suggested read carefully.
Information about your medical expense policy and hospital medical agreement
If during your stay in the Hospital you require more information or an additional service related to your insurance, we suggest you request it directly from your company, which should inform you to your satisfaction of the conditions of the Hospital Medical Convention, as well as the payment Of the deductible and coinsurance indicated in your policy and all those services not included or covered by it.
It is recommended that 24 hours before you settle your account, check in the Reception area, the existence of the Authorization Letter or Letter of Scheduled Surgery and the amounts payable for deductibles, coinsurance, expenses not covered, differences In fees, etc.
At the exit or discharge of the insured or beneficiary, this must be presented in the Reception area and liquidate the deductible, as well as expenses and services not authorized or covered by the company.
Payment of Medical Fees
The settlement of the medical fees as well as the corresponding co-insurance and differences in medical fees, if any, is done directly with the physician.