REQUEST OF HMO APPROVAL

UPON REQUEST OF APPROVAL, PATIENT MUST PRESENT THE FOLLOWING REQUIREMENTS:

  • HMO CARD

  • VALID ID WITH DATE OF BIRTH

  • (FOR CONSULTATION) NAME OF DOCTOR & CHIEF COMPLAINT OR THE REASON OF CONSULTATION

  • (FOR LABORATORY/PROCEDURE) DOCTOR’S REQUEST

HMO APPROVAL OPD & ER

OUT PATIENT DEPARTMENT (OPD)

  • CONSULTATION & PROCEDURES ARE ALL SUBJECT FOR APPROVAL

  • HMO STAFFS CALL FOR APPROVAL

  • APPROVAL TIME DEPENDS ON THE AVAILABILITY OF YOUR HMO’S CSR

  • NOT ALL CONSULTATION’S ARE PRE-APPROVED

EMERGENCY ROOM (ER)

  • PATIENT MUST SUBMIT THEIR HMO AND VALID ID UPON ASSESSMENT OF RESIDENT ON DUTY (ROD) AT THE EMERGENCY ROOM

  • ER STAFF WILL PROVIDE AN ER SLIP FOR THE PROCEDURE REQUEST BY THE ROD

  • ER PROCEDURES ARE ALL SUBJECT FOR APPROVAL

  • THE APPROVAL TIME DEPENDS ON THE AVAILABILITY OF YOUR HMO’S CSR AND YOUR CASE

APPROVED LETTER OF AUTHORIZATION

  • ALL APPROVED LOA MUST HAVE AN SPCMC HMO OFFICE STAMP

  • THIS IS TO ENSURE THAT PATIENT’S LOA IS VALID

  • WE ACCEPT OWN APPROVED LOA (PLEASE ALLOW HMO STAFF TO VERIFY ITS VALIDITY, HOSPITAL & DOCTOR’S NAME TAGGING

  • ASSISTING PATIENTS PRINTING OF THEIR PRE-APPROVED LOA BY SENDING IT TO OUR EMAIL/VIBER

ADVANCE APPROVALS (ONLINE/CALL)

  • WE ACCEPT ADVANCE APPROVALS (1-3 DAYS PRIOR TO YOUR PROCEDURE DATE)

  • YOU MAY CONTACT US AT

EMAIL: spcmc.hmoapproval@gmail.com
LANDLINE: (046) 484-3112 local 114
CALL/TEXT/VIBER: 0917-104-5670
CALL: 0918-610-5392

NOT COVERED DISAPPROVED

  • PRIOR TO PATIENT’S PROCEDURE,

  • WE ADVISED THE PATIENT THAT IF THE PROCEDURE IS NOT COVERED/DISAPPROVED

  • IT MUST BE CARE OF PATIENT OR THE PROCEDURE IS FOR CASH-OUT

  • IT IS ON THE DISCRETION OF THE PATIENT IF HE/SHE WILL PROCEED ON HIS/HER AVAILMENT

  • NO CANCELLATION ONCE THE PROCEDURE IS ADMINISTERED AND PROVIDED

FOR ADMISSION

  • HMO STAFF WILL REPORT THE ADMISSION TO ITS RESPECTIVE HMO

  • HMO STAFF WILL INQUIRE FOR THE PATIENT’S COVERAGE:

  • PATIENT HMO MBL (MAXIMUM BENEFIT LIMIT)

  • PATIENT HMO ABL (ANNUAL BENEFIT LIMIT)

  • ROOM AND BOARD

  • SPECIAL ENDORSEMENTS BY THE HMO’S CSR

  • DETAILS ABOVE MUST BE DISCUSSED THOROUGHLY TO THE PATIENT

  • ALL ADMISSION IS INCLUSIVE OF PHILHEALTH

  • PATIENT MUST COORDINATE WITH OUR PHILHEALTH SECTION

HEART STATION / RADIOLOGY

HEART STATION RADIOLOGY
* ALL PROCEDURE UNDER HEART STATION MUST BE SCHEDULED (EXCEPT ECG) * ALL PROCEDURE UNDER RADIOLOGY MUST BE SCHEDULED (EXCEPT XRAY PROCEDURES)
* YOU MAY REQUEST A SCHEDULE TO OUR HEART STATION DEPARTMENT LOCATED AT 3RD FLOOR * YOU MAY REQUEST A SCHEDULE TO OUR RADIOLOGY DEPARTMENT LOCATED AT GROUND FLOOR

FOR OPERATION

  • HMO PATIENT WHO WILL UNDERGO OPERATION PROCEDURE NEEDS TO COORDINATE HMO OFFICE PRIOR TO THEIR PROCEDURE

  • TO VERIFY AND INQUIRE IF THEIR PROCEDURE IS COVERABLE UNDER HMO

  • HMO STAFF WILL INFORM THE PATIENT REGARDING ITS COVERAGE

  • OR STAFF WILL ADVISE HMO STAFF WHO WILL BE THE ATTENDING PHYSICIAN AND ANESTHESIOLOGIST AND WHEN IS THE SCHEDULE OF THE PROCEDURE

  • PLEASE DO NOTE ALL OPERATION PROCEDURE ARE REQUIRED FOR AN RT-PCR TEST, SUBJECT FOR A SEPARATE APPROVAL BY YOUR HMO

  • ALL OPERATION IS INCLUSIVE OF PHILHEALTH

  • PATIENT MUST COORDINATE WITH OUR PHILHEALTH SECTION

FOR DISCHARGE

  • HMO STAFF WILL REPORT THE DISCHARGE TO ITS RESPECTIVE HMO

  • FINAL SOA OF THE PATIENT MUST BE SENT TO THEIR HMO FOR CHECKING AND EVALUATION

  • HMO AND PHILHEALTH BENEFITS WILL BE BASED ON THE FINAL DIAGNOSIS UPON DISCHARGE

  • ONCE REPORTED, SPCM C HMO OFFICE STAFF WILL WAIT FOR THE LOA

  • ACQUIRING LOA FOR DISCHARGE WILL DEPENDS ON YOUR RESPECTIVE HMO

  • HMO STAFF WILL INFORM AND UPDATE YOU TIME TO TIME REGARDING YOUR DISCHARGE STATUS

  • ALL MISCELLANEOUS / DISAPPROVED CHARGES SPECIFIED ON THE LOA WILL BE CARE OF PATIENT AND TO BE COLLECTED

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