Pre-Approval and Pre-Certification Agreements
When to Ask for Pre-Approval
Pre-approval must be requested from MSH International in the following cases:
- Any elective treatment costing over AED 2,000 per single treatment.
- Any elective treatment outside the United Arab Emirates.
- Elective inpatient treatment, daycare surgery, imaging diagnostic (ie., MRI, CT scan, etc.) and other services and procedures mentioned in your policy handbook.
How to Obtain Pre-Approval and Pre-Certification Agreements
|Within the Medical Network||Outside the Medical Network|
Simply present your Membership Card for Direct Billing to the Provider. They will contact MSH International to obtain Pre-Approval within 24 hours (for Elective treatment).
|2||MSH International will place the Letter of Guarantee and you will receive a copy of this letter by email.||MSH International will contact the hospital to issue a Letter of Guarantee and you will receive a copy of this letter by email.|
|3||You will only pay any applicable deductible, co-payment or any charges for non-covered items, as per policy terms and conditions.||
If the Letter of Guarantee is accepted by the hospital, MSH International will contact the hospital directly.
You will only pay any applicable deductible, co-payment or any charges for non-covered items, as per policy terms and conditions.
|4||The bill will be forwarded to MSH International for payment along with full details.||
If the Letter of Guarantee is refused by the hospital, you will have to pay then send us the invoices.You will have to follow the procedure “How to claim outside the network”. (A complete list is indicated in your policy handbook)
If the above-listed services are rendered at a Non-Network Provider without Pre-Approval, the Company reserves the right to decline your reimbursement claim.
If proven to be Medically Necessary, we will pay only 80% of the eligible benefit and for inpatient and outpatient Treatment or Services as per Usual, Customary and Reasonable (UCR) charges.
How to Claim Outside the Network
- You consult a healthcare professional and settle your fees.
Details of our international network of healthcare practitioners and hospital facilities are available at www.msh-intl.com/mena Participants’ Pages, under Your Healthcare. However, you are entirely free to choose your own healthcare providers.
- Fill out your reimbursement form on your Participants’ Pages (Fill out a Claim Form). Print and sign it.
We recommend that you group your claims together to avoid receiving reimbursements of very small amounts.
- Submit your claim
For a faster and even more efficient administration of your claims, you can upload your scanned supporting documents directly in your Participants’ Pages under Your Reimbursements / Fill out a Claim Form. This service is available for any claim (including several scanned medical bills) whose total cost does not exceed AED 2,000 (each uploaded file should not exceed 2MB – File format: jpg, gif, pdf).
You must keep the original copies of scanned documents for 24 months following the date of medical service as you may be requested to submit them at any time during this period. If the original copies cannot be produced, you will be responsible for all payments made on the basis of the scanned supporting documents received.
If the total amount of your claim exceeds AED 2,000, you need to send the original supporting documents including medical prescriptions, practitioner’s fees, bills and pharmacy price labels by mail to MSH International claims department on the address mentioned at the bottom of your Reimbursement Form.
- You will receive your reimbursement through bank transfer to the account of your choice and in your bank account’s currency or by direct transfer to your credit card.
If the currency of your bank account is not the same as the one in which you paid for your healthcare expenses, the exchange rate used to calculate your reimbursement is the rate issued by Edmond de Rothschild Bank on the last day of the month preceding the date of your treatment. You will bear any bank charges during the transfer.
- All expenses will be reimbursed according to the Terms & Conditions of your policy and based on Usual, Customary and Reasonable (UCR) charges.
For the settlement of your claims, you should submit to us the following documents within a maximum period of (90) days from the date of treatment:
- Reimbursement Form completed by the treating Physician
- Original itemised receipts of payment for the amount being claimed for (Invoice must show per service)
- Original full & detailed Medical Report, Diagnosis, Discharge Summary from the Physician
- Doctors’ prescriptions
- Results of any diagnostic tests