Medical Expenses and claims In-network administration
Objectives
PREVIMEDICAL takes care of administration tasks with access to one's personal Healthcare network, made up
of different healthcare facilities, such as Private Healthcare Hospitals, Hospital Companies, Research
Hospitals, Diagnosis Centres and Laboratories. The access is preferential and the payment is direct
to Health Facilities; the due amount is established in compliance with the Health coverage of the Company,
Bank or Corporate Fund.
Services Available
I) THE OPERATIONS CENTRE
The Operations Centre, through its own network/technical and insurance know-how, provides
medical insurance support when dealing with healthcare policies. The experts work alongside 22 doctors,
coordinated by a doctor in charge.
The Operations Centre is open from Monday to Sunday, 24 hours a day, National holidays included.
The Operations Centre implements the following activities :
- provides customised replies;
- carries out a medical insurance check verifying the eligibility of the service to provide;
- requests general information, the private healthcare facility and the name of the chosen medical team;
- books the services, granted by the health plan, in affiliated facilities;
- accurately checks the agreements with the medical team (complete in-network payment administration);
- provides the plan member with feedbacks;
- sends a fax 'to authorise in-network payment' to the Health Facility belonging to the
Health Network in compliance with the policys general terms;
- guarantees medical monitoring of the provided services (for hospital stays);
- performs medical operative back office activities (check of standard costs versus the agreement fees);
- pays directly the affiliated facility
II) HEALTHCARE NETWORK FOR PREFERENTIAL ACCESS AND AGREEMENT FEES,
TOGETHER WITH IN-NETWORK PAYMENT
The healthcare activity is highly qualified and wide-spread throughout all Italy thanks to selected
providers networks.
An ISO certified management procedure is provided both for new facilities (research, selection,
general information sending, documentation gathering, evaluation network doctors, in situ visits,
agreement contracts) and for affiliated providers (annual planning).
These are the main service features:
- a Health Care Network, made up of Private Health Care Hospitals, Hospital Companies,
Research Hospitals, Diagnosis Centres, and Laboratories, amounting to more than 3.000 affiliated
Health Care Facilities is available;
- Health Care Networks for urgencies and medical home care consist of: ambulances, specialists,
physiotherapists, nurses, social workers, dentists (mobile dentist site included), acupuncture
doctors and homeopaths, opticians, amounting to more than 2.000 qualified health operators;
- the network is selected according to ISO certificates;
- wide spread throughout Italy;
- dynamic;
- flexibility linked to administration tasks:
a) in or out-of-network administration
b) access to controlled fees
- customised budgets (hospitalisation time and costs);
- check-out monitoring for all claims managed with consequent additional authorisations for particular
cases and adjustments of the first budget;
- direct action on providers following reports for critical issues;
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