How to access the services provided directly

The direct form, as already mentioned, allows the Patient not to anticipate the costs of the services, choosing an affiliated healthcare facility and asking the Health Center for prior authorization.

To activate the direct access to services mode, the Patient will have to follow a few simple activities which we report below.

Choose the Healthcare Facility

First of all, it is important to check that the chosen healthcare facility, as well as the medical-surgical team (and/or the other specialists involved) have an agreement with the Health Centre. Access to the direct form, in fact, is only possible through affiliated healthcare facilities. The Patient can carry out this check by consulting the List of Affiliated Facilities, available in their Reserved Area, on the website www.mutuasicura.it (in the “Access to the Centre” / “Facility” section). Attention: in the case of surgical operations and/or hospitalizations, it is always advisable to contact the Health Center (or the chosen healthcare facility) to verify that the medical-surgical team has also signed up to the agreement. Within the Section dedicated to Affiliated Centres, it will be possible to search for the Facility by clicking on the Region of interest and choosing the type of facility to search for (e.g. Nursing Home, Physiotherapy Centre, Dental Practice, etc.). At this point it will be possible to view the list of Structures in line with the search parameters entered.

Book the Healthcare Facility

after verifying the presence of the Healthcare Facility in the Network, the Patient will have to directly book their service at the Healthcare Facility;

Request authorization from the Health Centre

at this point it will be possible to request the Authorization to Take Charge (PIC) directly:

1. Via fax at 06 77607611 2.
2. By ordinary mail to the address: Centrale Salute HEALTH ASSISTANCE, Via di Santa Cornelia n. 9 – CAP 00060 FORMELLO (RM)
3. By uploading the request directly to the Health Claim On Line portal (this procedure is recommended as it significantly reduces the time needed to define the procedures)
   To request authorization to take charge directly via Health Claim Online, it will be sufficient:

• enter your Reserved Area, in the “Access the Health Center” section, by clicking on “Take charge”;
• fill out the Form dedicated to Taking Charge;
• attach a photocopy of the medical documentation relating to the request (with the medical prescription indicating the diagnosis / diagnostic question, medical history form where applicable), by clicking on “Add Documents”.

For specifications relating to the Health Claim On Line functionality, please refer to the Operational Manual (available in the Health Assistance Reserved Area).

Attention! The request to take charge must be submitted to the Health Center at least 5 working days before the scheduled date for the service (for the purposes of calculating the useful days, Saturday is not considered a working day). Only in cases of proven urgency involving hospitalisation, which makes it impossible for the Patient to present his request within 5 working days before the service, he will still be able to request authorization directly, by sending the above documentation (directly or via the Healthcare Facility), within 5 days from the date of hospitalization, and in any case no later than the date of discharge from the Healthcare Facility itself.

The documentation must also contain the certificate from the doctor or facility with the reasons for the emergency hospitalization.

The authorization phase of the Health Centre

once all the necessary documentation has been sent to the Health Centre, the latter, having carried out the necessary administrative checks, proceeds to evaluate the request received (e.g., verifies the correct activation of the coverage, analyzes whether the requested service is under guarantee and congruent with the diagnosis indicated, check the completeness of the documentation presented and the maximum capacity, etc.).

Once the necessary checks have been carried out, the Health Center will proceed

• Authorize the request to take charge directly. In this case, it will communicate to the Patient (by sending an email communication) that the service has been authorized, indicating, where applicable, also the specifications relating to this authorization (e.g. maximum authorized amount, authorized service, etc. ). This authorization will be received within 48 working hours from the date scheduled for the service and only after complete documentation has been received for the purposes of assessing authorisation. At the same time, the Health Center will also authorize the chosen Healthcare Facility to provide the service with the direct payment service, indicating the amounts remaining to be paid by the Patient, in compliance with the provisions of the chosen Subsidy.
• Do not authorize the take charge request. The request for direct care may not be authorised, for example if the service is not provided for by your Health Plan, the maximum limit has been exhausted, it is inconsistent with the diagnosis indicated, sufficient medical documentation has not been provided to assess whether the case is covered or not. In this case, the Health Center will send the relevant communication to the Patient, via e-mail, indicating the reasons for the refusal; this communication will be received within 48 working hours.

The service provision phase

the Healthcare Facility, previously authorized by the Health Centre, will provide the service on the basis of what is indicated on the authorization form; will then ask the Insured to proceed with the payment exclusively of the amounts remaining to be paid by them, as provided for by the chosen Benefit (and indicated on the authorization form). The Patient must also take care to sign the authorization fax that the Health Center will have previously sent to the Healthcare Facility and which will be submitted to him by the Healthcare Facility itself. It will therefore be the responsibility of the Health Structure to send the medical and expense documentation relating to the service received to the Health Centre, in order to receive payment for the services and invoices. Please remember that the authorization constitutes a mere authorization to activate the service directly; in no case should the authorization be considered as a commitment and guarantee for the subsequent settlement which will take place only following further documentary evaluations and, therefore, only after the receipt of the complete documentation sent to Health Assistance by the Healthcare Structure, in compliance with the conditions of the Health Subsidy. We therefore invite you to read it before sending requests for acceptance (Pic).