APRIL Outpatient Direct Billing General Network
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APRIL Outpatient Direct Billing General Network INTRODUCTION AND TERMS OF USE APRIL’s Outpatient Direct Billing Network is designed to provide our members with a service that makes claiming for outpatient services quick and convenient. When members with outpatient benefits and holding a valid APRIL Member Card (or eCard) use medical facilities within our network, APRIL will settle eligible medical expenses incurred directly with the medical provider. Only members without coinsurance can use direct billing services. Please note that Moratorium policies are not eligible to this service. Use of this list is governed by your Policy’s Terms and Conditions and is also subject to the guidelines, exclusions and remarks listed below. Download our Easy Claim app on your smartphone to search and locate healthcare providers within our Asia network: With the app, you can: ✓ Search a healthcare practitioner by name, location, or specialty. ✓ Check whether you are eligible for direct billing in the displayed facilities. To verify your eligibility for direct billing, log in to the app and click on the “E-card” button: • If the code “DB” is displayed on your card, you are eligible for direct billing within our whole Asia General Network. • If the code “PNW” is displayed, you can enjoy direct billing within our Asia Panel Network (please refer to this listing). If you encounter any issues why using direct billing or have any questions about the service, please contact your local APRIL office. You may find your contacts below your eCard on your Easy Claim app. Inpatient Direct Billing For inpatient treatment, APRIL can arrange direct billing if proper notification and documentation are provided and subject to the hospital’s agreement. If you would like APRIL to arrange direct billing for inpatient services, please inform your hospital and notify APRIL at least 5 working days prior to admission or for a planned surgery/procedure/operation. Emergencies If you have an accident or emergency and urgently need APRIL to guarantee your expenses, please call 1 APRIL Assistance. Contact details can be found below your eCard on your Easy Claim app or on the back of your member card. Maternity Direct billing for outpatient maternity benefits may also be arranged within our network, but only with ONE PROVIDER per policy year (per pregnancy) to keep track of applicable sub-limits. Once you have decided on your sole provider within the network, please inform APRIL and we will provide a Letter of guarantee with a benefits balance for you to present to the clinic for record keeping. Eligible Outpatient Direct Billing Services The following outpatient services may be direct billed to APRIL: • General Practitioner consultation • Specialist consultation • Laboratory investigation* • General X-ray* • Prescribed medications obtained at the clinic on the same day of consultation. * Diagnostic procedures such as CT scan, MRI, Ultrasound, Mammography, or other investigations for chronic conditions as well as inpatient and outpatient surgery require pre-authorization which can be obtained by completing Section C of the Medical Claim Form and submitting it to APRIL for approval. Exclusions (See the Exclusions within your Medical Policy for full details) The following is a summary of conditions that are NOT ELIGIBLE for outpatient direct billing: × Pre-existing Conditions where coverage has not been expressly granted by APRIL. × Routine medical examinations or check-ups and Vaccinations. × Cosmetic surgery and reconstructive surgery. × Tests or treatment related to fertility, impotence or erectile dysfunction, contraception, sterilization, birth defects and congenital conditions. × Pregnancy or childbirth including pre-natal and post-natal care (except when agreed in writing by APRIL). × Prostheses and corrective devices. × Test or treatment of psychiatric, psychological, mental or nervous disorders. × Test or treatment for illness/injury as a result of excessive consumption of alcohol or narcotics or similar drugs or agents. × Sleep disorders × Learning difficulties, behavioral or developmental disorders or venereal disease. × Test or treatment in connection with Human Immunodeficiency Virus (HIV) related Illness including Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC). × Experimental or pioneering medical and surgery techniques. × Refractive defects of the eye, such as nearsightedness and astigmatism, spectacles, monocles or contact lenses. × Dentistry. Remarks • Providers may change from time to time. Please check with APRIL for the latest listings. • Members holding a valid membership card with a DB (Direct Billing) designation may receive cashless service at the below out-patient direct billing providers. • Members having outpatient benefits with 20% co-insurance will be restricted to the “Panel Network”. 2 Area Provider name Address Phone Website Cambodia Phnom Khema International 28, Street 294, Boeung Keng T: +855 89 911 911 www.khemahospital.com Penh Polyclinic Kong I, Phnom Penh Phnom 18, Street 528, Boeung Kak I, Tuol Khema Maternity & Clinic T: +855 23 880 949 www.khemaclinic.com Penh Kork, Phnom Penh Himawari Hotel Apartments, Phnom MW Medical (Cambodia) 313 Sisowath Quay, T: +855 23 223 322 www.mwmedical.com.sg Penh Phnom Penh 12207 No 161, Street 51, Sang-Kat Phnom Raffles Medical Phnom Boeung Raing, Khan Daun Penh, T: +855 23 216 911 www.rafflesmedical.com Penh Penh 12211, Phnom Penh 888 Russian confederation Phnom Royal Phnom Penh Boulevard Sangkat Toeuk Thla T: +855 23 991 222 www.royalphnompenhhospital.com Penh Hospital Khan Sen Sok 12102 177E, Kola Loum Street (the Bay Phnom Road), Group 2, Phum 2, Sangkat Sunrise Japan Hospital T: +855 23 260 152 www.sunrise-hs.com Penh Chroy Changvar, Khan Chroy Changvar, Phnom Penh Siem National Route #6 (Airport Road) The Royal Angkor Reap Phum Kasekam, Khum Sra Ngea T: +855 63 761 888 www.royalangkorhospital.com International Hospital (Angkor) Siem Reap (Angkor) Mainland China Bayley & Jackson Medical 7 Ritan Dong Lu, Chaoyang T: +86 10 8562 9998 www.bjhealthcare.com Beijing Center District Beijing 100020 Beijing 12 Tiantan Nanli, Chongwen District, T: +86 10 6703 5566 www.beijingpuhua.com Beijing Puhua International Hospital Beijing 100050 Beijing United Family 2 Jiangtai Lu, Chaoyang District, T: +86 10 5927 7000 www.beijing.ufh.com.cn Beijing Hospital Beijing 100015 Between Buildings 14/15, Jianwai Diplomatic Beijing United Family Residence Compound T: +86 10 8532 1221 www.beijing.ufh.com.cn Beijing Jian Guo Men Clinic (DRC), No. 1 Xiushui Street, Chaoyang District, Beijing 100600 2nd Floor, Tower 1, Poly Distinct HealthCare – International Plaza, T: +86 10 6479 2800 www.distinctclinic.com Beijing Wangjing Medical Center Wangjingdong Housing Estate, Chaoyang District Unit 103/202-204, Building C, Distinct HealthCare – Xingchuang International Beijing Xihongmen Medical Center, the intersection of T: +86 10 6022 3988 www.distinctclinic.com Center Hongye Road and Xinya Street, Daxing District S106-S110 Beijing Lufthansa Center, Beijing International Medical Center No. 50 Liang Ma Qiao Road, T: +86 10 6465 1561 www.imcclinics.com Chaoyang District, Beijing 100025 Suite 105, Wing 1, Kunsha Building, Beijing Raffles Medical Beijing 16 Xinyuanli, Chaoyang, District, T: +86 10 6462 9112 www.rafflesmedicalgroup.com 100027, Beijing Level 5, Office Tower B, Beijing New UMP Beijing Eaton Medical Beijing World Centre, Chong Wen Men Wai T: +86 400 680 8069 www.ump.com.hk Centre Street, Beijing 100062 Level 3 Kerry Centre Shopping Beijing Vista Medical Center Mall 1 Guanghua Road, T: +86 10 8529 6618 www.vista-china.net Chaoyang District, Beijing 100020 11th Floor, Tower A, Renhe New Distinct HealthCare – High- Chengdu www.distinctclinic.com Tech Zone Medical Center City,No. 505, Fucheng Avenue T: +86 28 8416 7266 West Section, Gaoxin District 11th Floor, Tower A, Renhe New Distinct HealthCare – High- Chengdu www.distinctclinic.com Tech Zone Medical Center City,No. 505, Fucheng Avenue T: +86 28 8416 7266 West Section, Gaoxin District 3 Area Provider name Address Phone Website Mainland China Room 9-12, 2nd Floor Chengdu Global Doctor South Entrance, Lippo Tower T: +86 28 8528 3660 www.globaldoctor.com.au No.62 Kehua North Road No.7, Unit 1, Building 2, No. 49 Tong Chengdu Leo Clinic T: +86 28 8694 5546 www.bhc-healthcare.com Ying Street, Jinjiang Chengdu 610065 Suit 2, 3F, No. 343, JinKai Avenue, Chongqing Global Doctor T: +86 23 6308 5550 www.globaldoctor.com.au Liangjiang New Area, Chongqing Room 401-402, 4th Floor, Business Building Block C3, Greenland Center Plaza, Dongguan Global Doctor T: +86 791 8882 3567 www.globaldoctor.com.au No.998 Honggu Middle Road, Honggutan New District, Nanchang City, Jiangxi Province Distinct HealthCare – Room 804-806, Block C-2, Poly Tai To Guangzhou Changlong Medical Wun, No.93 Hanxin Middle Road, T: +86 20 3106 0103 www.distinctclinic.com Center Panyu District Distinct HealthCare – Room 1205-1207, R&F Yingkai Guangzhou Zhujiang New Town Building, No.16 Huaxia Road, T: +86 20 3809 9090 www.distinctclinic.com Medical Center Tianhe District www.globaldoctors.asia/beijing- Nanjing Global Doctor No.283, Shui ximen Avenue, Jianye T: +86 25 8651 9991 alarm-centre/ District, Nanjing B1 Yadong Plaza,No.12 Xianyin North www.globaldoctors.asia/beijing- Nanjing Global Doctor T: +86 25 8662 8386 Road, Qixia District, Nanjing, Jiangsu alarm-centre/ 1788 Nanjing West Road, 1788 Square, Global HealthCare Shanghai Suite 303, Jing An District, Shanghai T: +86 21 5298 6339 www.ghcchina.com