InLife Health Care HMO Claims & Reimbursement Guidelines
The claims for reimbursement from Insular Health Care, Inc. (InLife Health Care) shall be governed by the following guidelines:
VALIDITY PERIOD:
1. A claim for reimbursement must be filed and received by InLife Health Care 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 thirty (30) working days from the date of receipt by InLife Health Care of the said claim; provided that the member has submitted all the necessary documents. In case an additional requirement is needed, the ten (10) day period shall be reckoned against the date when said additional requirement is submitted.
REQUIREMENTS:
1. All claims for reimbursement must be submitted together with a photocopy of the patient’s valid identification document (ID) and original copies of the following documents:
OUTPATIENT
Medical Certificate from the attending Physician or any document that would reflect the diagnosis. Official Receipts of payments to the Hospital and/or the Physician
Charge Slips with breakdown of charges
MEDICAL/ DENTAL BENEFIT
Medical Certificate from the attending
Physician/Dentist
Prescription
Official Receipt indicating the medicines purchased
INPATIENT
Medical Certificate from the attending Physician Clinical Abstract/Clinical History
Official Receipts of payments to the Hospital and/or the Physician
Charge Slips with breakdown of charges
Statement of Account
Operative Record including histopathological report (when applicable)
Police Report and/or Incident Report (for accidents and when applicable)