Request reimbursement for indirect services

The “Indirect Form”, as anticipated, is foreseen in cases in which the Patient has already benefited from the health/medical services, paying the related costs to the Health Structure, and requests reimbursement from the Health Centre.

The indirect form is therefore foreseen in two cases:

• In all cases in which the Patient has chosen NOT to use one of the Affiliated Healthcare Facilities;
• In cases where the Member, despite having used an Affiliated Healthcare Facility, has not however chosen to access the direct form, but has decided to advance the cost of the services.

To request indirect reimbursement of services, the Patient must send all the documentation through the following channels:

1. By fax to the number 06 77607611
2. By ordinary mail to the address: Via di Santa Cornelia 9 – 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).

Submit your refund request

The indirect reimbursement request must be submitted to the Health Centre. To request a refund on the Health Claim Online, it will be sufficient:

• Enter your Reserved Area, in the Access to the Control Unit section, then click on “New Request”;
• Fill out the form dedicated to inserting the refund request;
• Attach a photocopy of the medical and expense documentation (invoices) by clicking on “Add Documents”. For specifications relating to the functionality of Health Claim OnLine, please refer to the Operational Manual (available in the Reserved Area of Coopsalute).

Below is the documentation to be uploaded for the correct presentation of the case:

• Medical documentation, indicating medical prescription / diagnosis / diagnostic question / certified copy of the medical record, with specific indication of the healthcare services performed. It is advisable to always consult the Health Insurance to check which other documents are necessary.
• Documentation of expenses incurred, i.e. duly receipted invoices/receipts.
• The Network Access Form – duly signed by the Healthcare Facility – only if the services have been provided by an Affiliated Healthcare Facility.
• Certificates/reports/anamnesis/clinical record from which the onset of symptoms/diagnosis of pathology clearly emerges.
• Any other document relating to the services performed;

If necessary, the Health Center may request the integration of documentation aimed at correctly verifying the reimbursement or disbursement of the reimbursement/economic contribution. All the aforementioned documentation may be sent in copy and the Health Center may, if deemed appropriate, request the sending of the original documentation.

Attenzione!
If the indirect services have in any case been carried out at affiliated healthcare facilities, and in order to obtain the application of the preferential rates, the patient is in any case required to qualify, at the healthcare facility where the services will be provided, as of Associato Mutua Sicura. To this end, at the time of provision of the service, you must present the Network Access Form to the affiliated healthcare facility or to the professional. This Form must be specifically completed in its entirety and signed by the Healthcare Facility/Professional at the time of provision of the service and then be sent to the Health Centre, together with the Reimbursement Request Form and the necessary medical and expense documentation, as per indicated.

If the request for reimbursement of expenses is not accompanied by the Network Access Form completed and signed by the Healthcare Structure and the latter has not applied the preferential rates in favor of the Member, he will have the right to request reimbursement from Mutua Sicura of the expenses incurred within the limit of the Rates agreed between Mutua Sicura and the Healthcare Structure. The additional expenses incurred due to the failure to apply the Price List – determined by the failure to activate the agreement by the Member – will therefore be considered to be borne by the Member himself.

The original invoices and receipts incorrectly sent will not be returned to the Member after the case has been settled, unless the Member demonstrates that they have received an express written request from the competent financial authority. In this case, the originals of the aforementioned invoices will be returned after affixing the payment stamp indicating the refunded amount and the relevant date.

The Evaluation and Definition 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. Once the necessary checks have been carried out, the Health Center will be able to:

• Define the Refund Request with the payment.
  In this case, the Health Center will communicate to the Patient (by sending an e-mail communication) that the requested reimbursement has been positively defined, reporting in the communication the specifics of the reimbursement that will be made (amount that will be reimbursed, any expense quotas however remained the responsibility of the member, reference invoices, etc.). It may happen that the refund request is only “partially” defined. This can happen, for example, in cases where not all the benefits are provided for by the Patient’s Health Benefit or due to lack of capacity of the residual maximum amount, etc. The specifications relating to your practice will however be included in the communication sent by the Health Centre.
• Suspend the refund request due to lack of documentation.
  If the documentation sent by the Patient is not sufficient to carry out a complete assessment, the Health Center will suspend the Request and send the Member a communication (by e-mail), asking to proceed with the integration of the missing documentation. The Patient will have 60 days to proceed with integrating the documentation, including online; after 60 days, the authorization request will in any case be archived as rejected.
• Reject the refund request.
  The refund request may not be refundable, if e.g. the service is not covered by your Health Benefit, or the maximum limit has been exhausted, etc. In this case, the Health Center will send the relevant communication to the Patient, with an e-mail, indicating the reasons for the refusal.
  NB: the Client is advised to check the status of his/her case within the Reserved Area. In fact, all information is present in real time and makes it easier to define the position.

Payment for the practice

In the event that your request for reimbursement has been positively defined, the Health Center will proceed with the payment of the same in favor of the Patient. The refund will be made by bank transfer, to the bank details indicated by the Insured who holds the coverage.

Within a few days of finalizing the case, the Customer will receive a refund of the amount owed to them.