Read Phlippine-Network-Brochure-Version-4-18-07 text version

Payment System It is recommended to bring extra money/ credit cards in anticipation of financial responsibility such as co-pays, non-covered services. For the latest foreign currency exchange rate, you may inquire directly from the Bank of Philippine Islands (BPI) branch located at the 1st floor of Cathedral Heights Building, (same building where StayWell Manila Office is located). They also have an Automated Teller Machine (ATM) available to dispense peso currency. However it can only dispense about $400 worth of peso bills per day. Payment at the doctor's clinic is always in cash. For deductibles, always ask for an acknowledgment receipt that indicates the type and date of service performed as well as the amount paid for the service rendered by the doctor. The hospital facility accepts major credit cards. They also accept currency in dollars but at a much lower conversion rate compared to the bank.

Deductible Processing The following information is important when submitting claims for Deductible processing: MEDICAL/ LABORATORY Date of Service Provider's Name Provider tax ID no. Diagnosis code Treatment done Medical Record or Medical Certificate Itemized Charges Official Receipt FACILITY/PF Admitting History Diagnosis Breakdown of charges Discharge Summary Medical certificate--for professional component PRESCRIPTION MEDICATION Name of Pharmacy Name of prescribing doctor Date dispensed Name and strength of medication Quantity Itemized charges Proof of payment or official receipt Prescription slip for MD



NOTES: StayWell Guam Office: 430 W. Soledad Avenue Hagatna, Guam 96910 Phone: Fax: (671) 477-5091 (671) 477-5096


StayWell Manila Office: Unit 1602-1604 North Tower 16th Floor Cathedral Heights Building Complex St. Luke's Medical Center 279 E. Rodriguez Sr. Ave., Quezon City, Philippines Phone: Fax: Email: (632) 749-5476 (632) 877-1109 local 3431/32 (632) 722-2353 (632) 722-9587 (632) 522-2222 (632) 723-0101 ext. 5163 or 5164 (632) 723-3349 [email protected] 7 am ­ 4 pm, Monday to Friday 9 am ­ 1 pm, Saturday

Please take note that Deductible claims cannot be processed

when information is missing.

EMERGENCY HOTLINES: Office Hours: AceCor Ambulance Ninoy Aquino International Airport

Philippine National Police (24-hour)

Volunteer Fire Brigade

Hafa Adai! This pamphlet was created to assist you with your off-island care. We hope that your referral will proceed smoothly. Please contact our office for any assistance we may provide. OUTPATIENT REFERRAL Where is St. Luke's Medical Center (SLMC) located and how do I contact the hospital? SLMC is located at 279 E. Rodriguez Sr. Boulevard, Quezon City, 1102 Philippines. Landmarks near the hospital include St. Joseph's College, Trinity College and Delos Santos Medical Center. You may contact SLMC through: Trunk Line connecting all departments Fax Number Emergency Room E-mail Web Site (632)723-0101 (632)723-0301 (632)723-1199 (632)723-7328 [email protected]

* Note: There are certain services (including but not limited to elective admissions, ambulatory surgical procedures, major imaging or diagnostic tests, 2D echo, CT scan, MRI, colonoscopy, etc.) that require utilization review by our Medical Management Staff. Our Medical Case Coordinators may communicate with you and your physician to obtain relevant supporting information (e.g. consultation notes, laboratory test/imaging study results, EKG tracing, treatment plan and other documents) that would justify the request. StayWell will process the request as soon as possible though this will apply only to "clean" requests (requests accompanied by all pertinent information as enumerated above). The Utilization Review process for the LOA is not meant to interfere with patient care or to mitigate what you and your physician feel is appropriate. It only addresses StayWell's ability to guarantee coverage. 1. If a request for service is authorized, you will be given a corresponding LOA. Based on the type of health plan that you have, the applicable co-payment will be explained by StayWell Manila Office staff. Please be mindful of your schedule as well as the preparation required for the services you will undergo. If an adverse determination was made regarding a request for service, you have the right to appeal in writing to StayWell's Appleals/Claims Committee.


Charges for room and board are based on the time of discharge. In most facilities: a. There is no additional room charge if you are discharged before 12:00 nn. b. If discharged between 1:00-5:00 pm, a half-day accommodation will already be billed. Full day room accommodation will be charged if discharged beyond 5:00 pm. c. You may contact the StayWell Manila Office for clarification. Through the course of admission, our StayWell Manila Office staff will coordinate with you or your authorized representative in clarifying your financial responsibility and in directly settling a deductible, co-insurance or non-covered charge with the hospital cashier. For in-patient stay of more than 7 days, you will be provided with a list of itemized charges that are not covered under your plan. This will be updated on a weekly basis. Ho

HELPFUL HINTS DURING YOUR OFF-ISLAND REFERRAL Bringing along a companion is highly recommended. He or she may do the "leg work" for you (e.g. obtaining LOA forms) while in the Philippines as long as you authorize StayWell to release protected health information (PHI) related to your referral. As prescribed by law, your authorization should be in writing. Verbal authorization will not be accepted. When you are admitted at the hospital, you may be asked to pay for additional items such as: Drinking Glass Face Towel Linen/Extra Linen Mouthwash Rinsing Cup Shampoo / Conditioner Slippers Soap Spoon/Fork Tissue/Toilet Paper Wash Basin You have the option to bring these items in order to avoid extra charges. In anticipation of possible waiting time at the doctor's clinic, feel free to bring items for comfort (e.g. drinking water/beverages, snacks etc.)


2. Are all doctors at SLMC participating providers? Not all doctors at the SLMC are participating under StayWell's Network. Contact our office to ensure that a network provider sees you. Otherwise, you will end up with a higher out of pocket expense. Do I need a doctor's appointment before going to SLMC for care? In the Philippines, most doctor consultations are not arranged through an appointment process. When a doctor has a confirmed clinic schedule for a given day, a "walk-in" patient may be accepted on a first come, first served basis. Some clinics may offer a registra tion sheet to organize a patient numbering scheme. For details con cerning your preferred consultation schedule, please coordinate with our Guam Office so that they can provide the StayWell Manila Office with an advanced notice. Once you arrive in the Philippines, call the StayWell Manila Office before going to SLMC so that you can be ad vised about the best time to visit. Why do I need a Letter of Authorization (LOA) for every service? The LOA is the document that is used by the hospital or doctor to identify your insurance coverage and your financial responsibility. Because the provider deals with dozens of other insurance carriers, an LOA is required for faster identification and processing. What do I need to do before and after my scheduled visit or procedure at SLMC? Communicate with our StayWell Manila office to obtain LOA. If the provider you saw ordered medical/surgical services (ex. labs, admission etc.), you or your authorized representative will forward the request to the StayWell Manila Office for appropriate review. Once it is deemed a covered benefit and medically necessary, an LOA will be issued by StayWell and signed by StayWell's Medical Case Coordinators. The LOA will specifically indicate: a.) TREATMENT portion ­ procedure (e.g. outpatient con sultation, laboratory request, ancillary procedure, etc.) or prescription drugs you are authorized to receive. COLLECT portion - how much money in peso you would have to pay. Co-payment will vary according to insurance plan hence we will indicate how much is charged to the member. There are instances when your insurance pays 80% of the eligible charges and you would have to pay the remaining 20%

EMERGENCY SERVICES Do I need an LOA for emergency services? In the event of an emergency, an LOA is not required before receiving care. However you must obtain an LOA on the first business day following an emergency admission. Kindly inform our office so we can assist you in facilitating your care at the hospital. If an emergency room visit does not lead to an admission and your time of release from the ER falls outside the business operating hours of StayWell Manila Office, you may be required by the facility to pay for all charges incurred during the visit. This is because the facility will have no way of verifying the validity of your StayWell membership or your duration of off-island coverage under StayWell. If this happens, please obtain an official receipt, an itemized billing statement and your medical records, and contact StayWell Manila Office for assistance on the process of reimbursement.

Ons Once your physician has given the final discharge order, please get hold of the Discharge Appointment Slip from your designated Nursing Unit/Station and inform StayWell Manila Office once you have it. You may have your authorized representative contact the StayWell Manila Office using the telephone at the nurse's station nearest your room. Nevertheless, our StayWell medical case coordinators review your hospital records and they are able to anticipate your discharge. If you will be discharged during office hours, our StayWell Manila Office staff will assist your authorized representative in processing the paperwork required by the hospital. The StayWell Manila Office staff will visit your hospital room and together with your representative, proceed to the Hospital's Billing Department to obtain the final itemized billing statement. At the Billing Department, they will be able to determine any applicable non-covered charge or co-payment. Co-payment or noncovered charges should be directly settled with the Billing Department on the day of discharge. These charges would be indicated in the Discharge Reconciliation Statement (DRS) that will be issued to you by our StayWell Manila Office staff. If you will be discharged outside office hours, our StayWell Manila Office staff will anticipate the order from your physician and coordinate with you and your representative before the end of the working day. The StayWell Manila Office staff will endorse the necessary instructions to your representative in order to facilitate discharge clearance. 4. Take home medications are not covered when bundled within the inpatient hospital bill. However, take home medications may be purchased from the SLMC pharmacy at an outpatient setting if you request an LOA from the StayWell Manila Office.

Travel and Lodging Arrangements 1. If you need assistance in making travel and lodging arrangements, you must coordinate with the Guam Medical Referral Office (GMRO) before you depart for Manila. Their Guam Office may be reached through (671) 475-9350 or (671) 475-9307. In the Philippines you may also contact their satellite office at (632) 687-7950. For lodging reservations at a facility near SLMC, you may contact agents including: Garden Heights Condotel: Robbinsdale Hotel: (632)723-9181 (632)716-2588 (632)716-1262 (632)716-2581


Cathedral Heights Building Apartelle--SMLC Admission Office: (632)723-0101 local 5513 3. If you enter the Philippines as an airline medical r ef err al case, you must ask your attending physician to accomplish the Medical Information Form (MEDIF obtained from the airline office) prior to your departure back to Guam. This document should be submitted via fax or hand-carried to the airline office at least three working days before depar ture date for approval by the airline physician. Contact your airline for further details. Continental Airlines Northwest Airlines Philippine Airlines (632) 818-8701 (632)841-8800 (632) 855-8000 local 2241 (632) 852-6088

ADMISSION & DISCHARGE I am scheduled for an elective inpatient admission. What documents will I need from StayWell? Once an elective procedure is authorized, you will be given an LOA that should be presented to the Admitting Office together with your doctor's admitting order. The Admissions Office is located at the first floor of the hospital building, near the entrance to the lobby. I would like a private room, is this covered? StayWell covers inpatient stay at a semi-private room. If you opt to get a private room, you will be asked to pay the room rate difference (private room rate minus semi-private room rate). Should you decide to choose a suite room, you will likewise be asked to shoulder the room difference plus incremental charges on professional fee, ancillary services and supplies.

MEDICAL RECORDS 1. For every procedure requested by your physician, you will be asked to pick-up the paper copy of the results from a designated place and on a designated date and time. If unsure about the process, please confer with our StayWell Manila Office since it is important that you have a copy of your medical records when you return to Guam/CNMI. It is advisable to obtain the result of imaging studies in electronic format (CD or DVD) for continuation of your care in Guam or in another facility. This may be requested from the involved Imaging Section for a nominal fee. 2. For inpatient medical records, it is advisable to request for a copy of the records during the course of your admission. This will give ample time for the Medical Records Department to collate your file and for the records to be available in at least three to five working days after discharge date. Certification for airline and immigration requirements should be requested directly from your attending physician.


If you anticipate stay of more than 21 days in Manila, you must apply for an applicable visa at the Philippine Consulate Office in Guam at least three business days prior to your departure. You will need to bring a copy of your latest pay slip/check stub, passport, 2x2 inches picture and your round trip airline ticket. For details, you may call the Consulate at (671) 646-4620. During your travel to Manila, your passport should still be valid for at least six months.

Important admission and discharge information 1. Our Case Coordinators will review and monitor the course of your care on a daily basis. This is done to review and determine if the medical/surgical services provided, or to be provided, are medically necessary and at a level adequate to provide appropriate and quality care. To help maximize its members' benefits and reduce potential complications associated with avoidable inpatient days, StayWell uses the nationally recognized Milliman Care Guidelines to review length of stay and medical necessity.




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