Important Health Insurance Notes
We have a VIP SERVICE to help you at the hospital or clinic.
We are fluent in Spanish and English and can help you communicate with the hospital staff doctors and administrators.
Normally when someone is sick you go to the hospital or clinic and make sure they take insurance first . If they don't take insurance you can not get reimbursed.
If there is ever an issue at the clinic for example with your insurance,
sometimes they say the insurance is inactive call us from there at
829 466 1234 and we will help make sure it is good.
We will speak to the secretary administrator or doctor while you at at the clinic.
Often they will say that your insurance is inactive so they can get your quick cash instead of doing paperwork and waiting for their money form the insurance company.
If you pay cash to the lab ,doctor or hospital it is very difficult to get a refund. It is much better to contact us while at the clinic if there is a problem with accepting the insurance , than paying cash and trying to get your money back.
If you do pay cash, and want a refund from Humano ,you need to go to the nearest Humano insurance office and make a claim for the refund. The form will look like this
Information required for a refund are stamped original receipts you paid , dates of your visit ,date of admitting and date of discharge, , name of doctor and specialty , type and reason for the treatment , name/contact info . of clinic , information on your health card. Additional information may be required as well .
If it is something serious you are always better to go to the larger hospitals
for example in Santo Domingo , Punta Cana , Santiago, Puerto Plata where they have access to all services.
Pre-Approval /Authorization is needed for most tests
For some lab work ,non-emergency surgurys, CAT scans , MRI, and other tests you need the insurerer Humano for example to authorize them first.
For authorization you get a stamped and signed authorization /prescription from the doctor and get it approved by Humano first . including the name of the place where you will be getting treatment. Make sure they take insurance .
Then you take this authorization to the clinc where you are getting the tests done. Then you take this authorization to the clinc where you are getting the tests done.
This can be done in any Humano office for example if you have Humano Insurance.
Some larger hospitals /clinic have insurance offices where theywill do it right there for you .
You can also send us the Approval Request and we can get it done for you and email it to you . Usually this takes about 24 to 48 hours .
Other notes
.All plans do not cover the cost or delivery of blood for transfusions
WAITING PERIODS
For some tests including CAT scan and MRI scheduled /non emergency Surgeries Catastrophic illnesses there is a waiting period of 6 months unless it is determined by the doctor to be an emergency.
For maternity/child birth there is a 6 month waiting period prior to being pregnant.
Emergencies are always covered right away
Insurance does not cover pre-existing conditions
You need to give us 30 days notice to cancel.
Cost /benefits of group vs an individual plan which is not a group plan
You can join an individual plan with Humano before 65 years old.
Mapfre only has group plans after 65 years old .
With the group plan payments are due on the 20th of every month for the following month .
Payment is by credit card taken by the insurance company for monthly deductions , or pre-payment for 6 months or 1 year.
.Note If payment is not received on or before the 20th then people are removed from the group automatically, and they will have to rejoin.
With an individual plan payment is with a credit card to humano for monthly deductions,or for pre-payment for 6 months or 1 year. .
Humano automatically deducts monthly amount t unless it is for 6 months or one year .
If there is a problem processing payment then the insurance becomes inactive , however it can be reactivated up to 2 months later with paying all moneys due.
With individual plans there is a payment customer portal.
On this portal, people can also look at their insurance policy status , see their health cards,check payment status, and submit receipts for expenses paid ( depending on the situation)
With the group plan there is no portal.
Refunds
If you had to pay cash for something, , you may be able to get re-payment for signed stamped receipts you get from the hospital or lab etc. by going to the nearest Humano office or by filling out a form we provide , and sending us this and a copy of the receipts. .
Please note. Normally you cannot get a refund if you paid money to a lab ,doctor hospital etc that does not take insurance .Make sure they take insurance first.
The rare exception is when you are far away from a hospital , If there is a doctor strike , or if there is a system malfunction.
If there is ever a problem with your insurance getting accepted you must call us at 829 466 1234
then from the clinic/lab or hospital and we can help you then at that moment and speak to the doctor secretary etc.
Refund/payment is made by cheque or deposit into your client's bank account provided on the refund form.
Humano will contact you when it is ready by email or normal tel ( not whatsapp) you provide on the claim.
In case of the payment by check , we can get this and send it to you via courier ( at your expense