Medical Reimbursement

The claims for reimbursement from Insular Health Care, Inc. (iCare) shall be governed by the following guidelines:

a. Validity Period
1.  A claim for reimbursement must be filed and received by iCare within sixty (60) days from (i) the date of availment for outpatient benefits; or (ii) the date of discharge for inpatient benefits.

2. The period for processing shall be twenty-one (21) working days from the date of receipt by iCare of the said claim, provided that the member has submitted all the necessary documents. In case an additional requirement is needed, the twenty-one (21) day period shall be reckoned from the date when said additional requirement is submitted.

b. Requirements
All claims for reimbursement must be submitted together with a photocopy of the patient’s valid identification document (ID) and original copies of the required documents as listed in the Claims Reimbursement Form.

Requirements:

• • Fully accomplished Claims Reimbursement Form.
  • Photocopy of the patient's valid ID
  • Medical certificate stating chief compliant and final diagnosis
  • Clinical abstract/Clinical History
  • Original copy of official receipt from facility and doctor
  • Statement of account
  • Itemized breakdown of charges or charged slips
  • Operative Record including histopathological report (when applicable) 
  • Police report and/or Incident Report (for accidents and when applicable)

Requirements:

• • Fully accomplished Claims Reimbursement Form.
  • Photocopy of the patient's valid ID
  • Medical certificate stating chief compliant and final diagnosis
  • Original copy of official receipt from facility and doctor
  • Itemized breakdown of charges or charged slips