How to access the services provided directly
8 March 2022Communicate with Mutua Sicura
8 March 2022This section contains the main information for correctly accessing healthcare services provided directly and indirectly.
Access to services and the management of related reimbursements, as well as the Telephone Assistance Service, are provided by the HEALTH ASSISTANCE Health Centre, which operates as Service Provider of Mutua Sicura. For this reason, during acceptance at the affiliated facilities you are asked to always refer to the Health Assistance company.
Mutua Sicura provides a Reserved Area from which it will be possible to access the platform.
Below is some preliminary information for the provision of the services provided by your Health Benefit:
How to contact the Health Centre
The Health Center is the office dedicated to managing requests for reimbursement of expenses and requests for authorization for the direct form and is managed by operators with many years of experience in the sector.
The Center has the task of providing all useful information and support to the Patients for accessing services.
The Health Center can be contacted:
- By calling the toll-free number 800 511 311. The number is active from Monday to Friday from 8.30am to 5.30pm and on Saturday from 8.30am to 12.30pm;
- By sending a fax to the number 06 77607611
- By filling out the Online Form available within the Online Health Claim in the Reserved Area (accessing from the Home Page of the Reserved Area, in the section click on “Access the Centre” / Request Information).
What is Health Claim On line
Requests for reimbursement or direct care are submitted by accessing the online functionality made available by the Health Centre. Patients will be able to access this functionality from their Reserved Area, from the institutional website www.mutuasicura.it, by clicking on the “Log in to the Center” box.
The Web Information System, called Health Claim Online, allows Members to:
- Carry out online refund requests (indirect form) and take charge requests (PIC), directly uploading all the necessary documentation;
- Forward the medical and expense documentation requested for “integration” and necessary for the purposes of defining reimbursement requests already forwarded incompletely (in the case of practices in a “suspended” state);
- Check the processing status of requests forwarded both indirectly and directly (PIC acceptance requests);
- View all the documentation submitted and the justification notes for any suspended/rejected refunds and download the related communications;
- Check the reimbursed expenses, the non-reimbursable expenses (with explanatory note), the expenses remaining borne (according to the chosen Subsidy) with an indication of the invoices to which the reimbursements refer;
- Generate/download/print the summary “Settlement Statement” (selecting by year of competence and for the entire family unit or for the individual Patient), containing the analytical detail of all the expense invoices presented (with indication of number and dates invoices, requested amounts, refunded amounts, amounts remaining dependent on the Subsidy, non-refundable amounts, amounts already credited, etc.), also useful for tax return purposes;
- Send a communication to the Health Center (e.g. to request more detailed information on your practice, report a facility, receive clarifications on your subsidy, etc.).
To find out in detail all the functions of the Health Claim Online, the Health Claim Online Operational Manual is available to the Patient in the Reserved Area.
What is the “Direct Form”
The “Direct Form” is access to healthcare services at facilities that are part of the Health Center Network, subject to authorization being issued by the Center itself; in this case, the Patient will not have to pay any amount in advance (with the exception of the expenses he/she may have to pay if foreseen by the chosen Health Subsidy).
What is the “Indirect Form”
The “Indirect Form” is access to healthcare services at affiliated or non-affiliated facilities and carried out by the patient without prior authorization from the Health Centre; in this case, the Patient will have to pay for the services to the Health Facility and subsequently request reimbursement from the Health Centre.
What are Expense Quotas?
The “Cost of Expenses Paid” are those expenditure amounts relating to healthcare services which, in any case, remain the responsibility of the Patient; the reimbursement of expenses, therefore, will be carried out by the Health Centre, net of these amounts.
The expenditure quotas are normally indicated as a percentage or as a fixed quota; they are expressly indicated in the specific guarantees provided by your Health Benefit and may vary if the service is provided by an Affiliated Health Facility or by a non-Participated Facility.
What is meant by Ceiling
The “Ceiling” is the maximum overall sum within which the Mutua will bear the costs of the services provided by its Health Subsidy. This amount is reported in the specific guarantees, and refers to the set of services that refer to the guarantee (e.g. maximum for hospitalizations, maximum for high diagnostic services, etc.). The maximum amount is normally intended as a total for all members of the assisted family unit, and does not vary based on the number of family members (unless otherwise indicated in the specific guarantees).
What are Deficiencies (expectation terms)
The deficiency is a period of waiting, starting from the date of activation of the Health Subsidy, which underlies the operation of the guarantee (for example, some Health Coverages provide that the guarantee relating to childbirth operates starting from the 270th day of activation of the Subsidy same).
In case of doubts, you can request preventive information from the Health Centre.
What are Precedents
By “Previous” we mean all pathologies or consequences of pathological states due to illnesses or injuries that have already occurred/known, diagnosed or treated before the date of joining the Health Benefit.
Some Subsidies expressly provide for the exclusion of “Previous” health benefits from coverage, for which the related and consequent healthcare services are considered non-reimbursable/compensatable. We always invite you to check the definitions available to you in the introduction to the Health Benefit regulation. In cases of doubt, you can always request preventive information from the Health Center on the toll-free number 800 511 311.
How to present your practices
To send your applications you need to access the Central functions and upload your requests. Alternatively, if you do not have internet access or the ability to scan the necessary documentation, requests for reimbursement or direct care can still be sent to the Health Centre:
- by ordinary mail to: Centrale Salute Health Assistance, Via di Santa Cornelia n. 9 – CAP 00060 FORMELLO (RM)
- by fax, to the number 06 77607611
