Medical Availment Guidebook & List of Accredited Network of Health Providers
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Medical Availment Guidebook & List of Accredited Network of Health Providers Generali Pilipinas Life Assurance Company, Inc. Generali Philippines is a joint venture between two financial giants: the global insurer Generali Group and Banco De Oro Unibank Inc. (BDO). The Generali Group is one of Europe’s largest insurance providers and the biggest European Life insurer. It is also one of the world’s top asset managers with assets of over € 460 billion. With 82,000 employees worldwide and 65 million clients in more than 60 countries, the Group occupies a leadership position in Western European markets and an increasingly important place in Eastern Europe and Asia. In the Philippines, our partner Banco De Oro Unibank Inc. (BDO) is the financial services flagship of the SM Group of Companies, one of the country’s largest and most successful conglomerates with businesses spanning retail, mall operations, property, banking, hotels and convention and leisure facilities. Today, BDO is the country’s largest bank in terms of assets with over 720 branches nationwide. BDO is multi-awarded by various leading international institutions, which include Finance Asia, Alpha Southeast Asia, The Banker, The Asset, Asiamoney and the Asia CEO Awards. The partnership was signed on 26 March 1999 and formally launched on 9 March 2000. 3 Generali Philippines INTRODUCTION The GENERALI PHILIPPINES (GP) Provider Network refers to our nationwide network of GP accredited Hospitals, Clinics and Doctors. We refer to each accredited Provider as our health partner in the provision of the best health service for all of our members based on their Medical Plan wherever they may be nationwide. We consider each Provider facility as a place of convergence for all of our GP members for quality healthcare delivery in the community where they live in. The general direction of the GENERALI PHILIPPINES Provider Network under the GP Group Business Provider Network Administration Department (PNAD) is always towards strategic expansion and provision of quality healthcare to our members. At present, Generali Philippines has fully accredited 267 Hospitals and 218 Clinics manned by over 15,000 Generali Philippines accredited Medical Specialists covering ALL Medical Specialties nationwide. Generali Philippines prefers a more selective approach in the conduct of our continuous nationwide Provider Network expansion. It is not our goal to accredit any and all providers that come our way but prefers to be more discerning in our approach. We would always apply our accreditation and credentialing standards in our selection process to ensure quality healthcare provision to our members. Furthermore, our selected providers are already strategically located where our present membership base is with on-going further expansion to locations where we project further membership growth in the coming years. The “Generali Philippines Medical Availment Guidebook and List of Accredited Network of Health Providers” is part of the commitment of Generali Philippines to provide YOU, our valued members a readily available guide to facilitate easier access to the best medical care our nationwide Network of Providers can offer. This Guidebook primarily contains the list and contact details of all of our accredited hospitals, clinics and coordinators/HMO offices nationwide arranged by region. It also contains information on our standard availment procedures which would make it more convenient for you to access quality healthcare. Please take note that the Generali Philippines List of Accredited Network of Health Providers nationwide is constantly evolving due to our rapid expansion and regular review of the list as part of our accreditation standard applications. As a result, the contents of this publication may change without prior notice to our members. We will publish updated versions of this booklet moving forward as necessary to reflect latest information. You may also refer to the GP Alarm Center numbers for any inquiry on particular Providers. 4 Introduction ............................................................................. 4 Availment Procedure for Accredited Providers ......................... 7-8 Availment Procedure for Non-accredited Providers ..................... 10 Accredited Hospitals National Capital Region ................................................. 12 -16 Cordillera Autonomous Region .......................................16-17 CONTENTS Region I ..........................................................................17-18 Region II ..............................................................................18 Region III ....................................................................... 18-21 Region IV-A ................................................................... 21-26 Region IV-B ....................................................................... 27 Region V ............................................................................ 27 Region VI ...................................................................... 27-28 Region VII .................................................................... 28-29 Region VIII ................................................................... 29-30 Region IX .......................................................................... 30 Region X ........................................................................ 30-31 Region XI ............................................................................ 31 Region XII ...................................................................... 31-32 CARAGA ............................................................................. 32 Accredited Clinics National Capital Region ................................................. 32-40 Cordillera Autonomous Region ............................................ 40 Region I .............................................................................. 40 Region II ............................................................................. 41 Region III ....................................................................... 41-42 Region IV-A .................................................................... 42-45 Region V ............................................................................. 45 Region VI ....................................................................... 45-46 Region VII ...................................................................... 46-47 Region VIII .......................................................................... 47 Region X ........................................................................ 47-48 Region XI ............................................................................ 48 Availment Procedures in Generali Philippines Accredited Network 6 Medical Availment OUT-PATIENT (OP) Availment Procedure: 1. Proceed to GP-accredited hospital/clinic, look for the Medical Coordinator/HMO office and present the GP membership card and company ID to him/her. 2. APPROVAL: eligibility verification by the Provider (Medical Coordinator/HMO office staff): a. If member presents the old GP membership ID (non swipe): i. Call GP Alarm Center (AC) for approval and OP LOA request. ii. AC approves availment then sends OP LOA or dictates LOA approval code (for Providers with GP LOA pads). b. If member presents the GP Swipe Card: i. Swipe member card to Medilink POS Terminal to alert GP AC to the availment and for Letter of Eligibility (LOE) print out. ii. GP AC will call the Provider staff to approve availment and OP LOA Issuance. 3. Once availment is approved, the Medical Coordinator will perform initial OP evaluation or treatment which may result to: a. Referral to GP-accredited Specialist for further evaluation/treatment OR Laboratory/diagnostic exam request/s- if necessary. Member: i. Secures APPROVAL from the Coordinator’s Clinic / HMO office (step 2 above). ii. Presents LOA to Accredited Specialist OR signed lab/ diagnostic Request Form and LOA to the Laboratory Department for examination. b. Admission (see IN-PATIENT Availment Procedures below). IN-PATIENT (IP) Availment Procedure: 1. GP Hospital Coordinator (HC) and/or accredited Specialist shall issue admitting orders to the member. The GP HC and/or accredited Specialist shall serve as Attending Physician. 2. Member proceeds to GP-accredited Hospital Admission Unit and presents GP membership card, admitting orders, company ID and PhilHealth Form. He/she may also bring the IP LOA if this was prepared ahead of time by the GP Alarm Center (AC). 3. APPROVAL: eligibility verification by the Hospital Admission Unit staff: a. If member presents the old GP membership ID (non swipe): i. Call GP AC for approval and IP LOA request. Once approved, IP availment will proceed. ii. GP AC will send the IP LOA within 24 hours from admission. 7 Generali Philippines b. If member presents the GP Swipe Card: i. Swipe the member card to the Medilink POS Terminal for approval and Letter of Eligibility (LOE) printout. Once approved, IP availment will proceed. ii. GP AC will call the Hospital Admission Unit staff for IP LOA Issuance within 24 hours from admission. 4. The Hospital will inform the GP Hospital Coordinator of the admission. 5. The member will be admitted based on his/her medical benefits. 6. The member settles charges in excess of his/her benefits. Emergency Room (ER) Availment Procedure: 1. Member presents GP membership card at the GP-accredited hospital Emergency Room. 2. Emergency Room (ER) Physician carries out initial evaluation