In the event of hospitalization in a public or private facility, or in the event that the insured requires a specialist doctor’s visit, diagnostic testing, medical assessment, dental services, etc… the insured has the option to stay in the PREVIMEDICAL network or not:
- In the first case, benefits can be provided for under a direct assistance scheme ; the Insurer shall directly pay the network facility . In this manner, the insured does not anticipate any amounts , to exclude deductibles and overdrafts which remain at his expense. to obtain authorization, the insured needs to contact the Operations Center in advance :
In the event of an emergency, it is mandatory to complete the requested forms provided by the Operations Center and send it by fax or Email attaching the physician’s request for services to be provided to the insured.
For requests other than the activation of the direct payment service, or for any additional information, please contact email@example.com or firstname.lastname@example.org addresses.
- In the second case, the reimbursement will be provided by an indirect payment assistance scheme; the Insured will receive the reimbursement of expenses incurred, within the limits of the option of coverage selected by the Insured. Once the medical service has terminated, the Insured must submit the relative documentation on line as indicated in the claims handling procedure , indicated in the “Confidential Reserved Area“. The Insured may also track down the status of his reimbursement in this area . As an option, the Insured may also complete the request for reimbursement by attaching complete medical documentation to his email or regular mail.
Claims must always be accompanied by official documents regarding expenses incurred and submitted to PREVIDIR in one of the following ways:
- by email, uploading the documentation on the refund request section of the web site; documents will need to be scanned and then processed;
- by paper and standard mail, simliar as above, BUT never original documents.
The copy of the expense documentation must be complete with stamp marks in the regulatory cases and in any case the documentation must be fiscally in accordance with the legal provisions time in place, subject to inadmissibility of the claim.
Otherwise, the claim will be rejected; it is possible to re-apply for reimbursement only if the Policy holder can submit expense documents / invoices , through an Eligible Company with a document issued by the local office of the Revenue Agency. Alternatively, the application for reimbursement is allowed to be re-proposed in the event of the cancellation and reissuance of the expense document, in the cases that are legally permitted, provided that it is branded with a stamp and issued in accordance with the provisions of the tax fiscal laws. In that case, the invoice must still show the date on which the services were rendered.
The Fund, after verifying the validity of the requests and the completion of complete proper documentation, loads them into its management system, in accordance with those of the Insurance Companies responsible for covering the risk.
In the “loading” phase of the requests, the management system is able to determine the exact amount to be reimbursed, obtained by applying the “rules” related to the option chosen by the Insured. (e.g. deductibles, the level of “consumption” of the limits of coverege provided for each service, etc.).
Having carried out this procedure, which can be treated as a kind of “preliquidation“, the Fund, on a weekly basis, transmits by computer all requests submitted to the Insurance Companies for indemnifying the insured based on the option chosen for coverage . The latter then handles administratively the payment of the claim, and arrange for the amounts owed to insureds to be paid by issuing the relevant bank tranfer in favour of the insured.
The subscriber has the opportunity to monitor the “progress” of their requests and check the accuracy of the fulfillments through their “Confidential Area“.
In cases where the “standard procedure”, for any reason (e.g. doubtful compensation, contrast on exact quantification, computer problems, etc.) Fund operators are responsible for providing members with all the assistance they need to solve the technical solution of unresolved cases.
- Using The Contracted Health Facilities
Within the site, in both the public and confidential sections , all the necessary and useful information is available for the proper use of the services indicated in the area “ Direct Convention.”( IN NETWORK )
In addition, to learn more about public and private clinics , including Dental Offices , under contract with the Previmedical S.p.a. network, click on the area “Conventional Health Facilities” to activate the service toll-free phone number 800.994.880. We remind enrollees that it is possible to propose to their specialist doctor and/or dentist to accredit themselves to the Previmedical network by submitting the request to https://www.previmedical.it/accreditamento_centri.html
For further informations you can consult the Service manual