Hospitalization
La Médicale receives medical reports either directly from hospitals or from insurance companies by Fax or E-mail; these reports are thoroughly analyzed with the guidance and advice of the company's doctors who cover all specialties. These doctors give their medical opinion and the claim center gives the administrative report and the final result will be sent to the insurance Co.
Furthermore, La Médicale keeps a steady close contact with the treating physicians. This goal is achieved by sending control physicians to follow-up all In-Hospital cases. These doctors report back by writing, all the gathered information which will be examined by the appropriate doctors in order to determine the coverage of either medical or surgical acts or the hospitalization period.
Ambulatory
Three different ways to benefit from these services:- The patient goes directly to the hospital or the laboratory in the network, does the tests and X-rays, and pays the bill according to the applicable tariff of La Médicale. And then he will be paid by the insurance Co, taking into consideration his policy conditions.
- The patient goes directly to the insurance Co or sends a report concerning the ambulatory services ordered by his physician, and gets the approval directly or through Fax, or the approval will be sent to the hospital in the network where the tests are to be done.
- The patient undergoes the ambulatory services in any medical center he wants, pays the bill and presents it to the insurance Co In order to be reimbursed according to the applicable tariff of La Médicale network.
Processing the bills
- Medical control.
- Financial and administrative audit.
- Edition of detailed reports to the insurance companies.
- Acknowledgment of eventual deductions to the concerned hospitals after reaching an agreement with all parties: hospital, doctor and patient, in order to maintain a good relation between La Médicale and them..
- Edition of financial reports summarizing the figures of the bills (In, In + Out, Out) per hospital and per insurance Co.
The insurance companies working with La Médicale would benefit from the following advantages:
- The above mentioned control and processing program.
- Preferential tariffs provided exclusively by the hospitals to La Médicale
- Special deductions offered annually by some hospital according to the respective turnover of all companies working with La Medicale.
Services
Our list of services is divided into three categories that you can benefit from, to help you as much as we can, for that reason we accompagne you from hospitalization to ambulatory and processing.
