Introduction

Our staff specializes in the area of insurance claims and counsel, providing the link between the insured patient and the insurance company.

We have arrangements with Mexican insurers who provide major medical, medical, accident and automobile insurance, and with foreign insurance companies providing major medical coverage.

Information – Services

Authorization forms

Seven days ahead of time, our staff helps to complete the paperwork necessary to solicit the insurance provider’s authorization for surgery or other procedures: the advantage is that knowing each company’s conditions expedites such authorization. We can foresee any deductible and coinsurance amounts that may apply, as well as payments to the attending physician and his or her team, the amounts authorized for hospitalization costs, etc. 

Documents required for processing the authorization are:

• Notice of accident and/or illness, completed by the insured
• Medical report duly filled out by the attending physician
• Copies of diagnostic tests with medical interpretation, laboratory results, etc.
• Copy of both sides of patient’s official identification
• Copy of both sides of currently valid insurance card
• Once provided with the accident notice and medical report, the Insurance Department will review all documentation and, if it is in order, will proceed with authorization request
• On the agreed date, the office will contact the insured with the insurance company’s determination, and will then, along with the physician, schedule the operation or procedure.

Steps for authorizing direct payment

If you are not able to schedule your surgery or procedure before being hospitalized, we ask that you identify yourself as being insured when you are admitted (see the list of insurance providers with whom we have agreements.) Please also provide identification and your insurance card, so that we may take copies. Admissions will notify the Insurance Department of your hospitalization.

Our staff will then report to your insurance company. A department representative will make sure you receive the forms which you (notice of accident or illness) and the attending physician (medical report) must complete.

It is very important that you help us by completing documents as soon as possible; in accordance with the insurance providers’ conditions, direct payments are determined within 24 hours from the time data is received.

If the insurance company requires more information from the physician, or hospital billing statements, we will take responsibility for obtaining and sending them.

When the insurance company issues its answer, we will contact you and personally explain it to you and your attending physician. We will also notify any relevant internal hospital departments.

The attending physician may submit the paperwork for those fees that have been authorized by the insurance company to us, so that you need not be inconvenienced by paying and awaiting reimbursement.

Emergency authorization

If you are treated in the urgent care department, please identify yourself as a policyholder when you arrive: we have several arrangements that offer direct payment even when a patient is not admitted to the hospital. Department staff will let you know whether your company has this benefit or not.

If you are hospitalized, we will follow the same steps that are outlined in the preceding section.

In case that you arrive for treatment via an automobile insurance company, please present admissions staff with the documentation you received from the adjuster.

To complete the paperwork for reimbursement by your company, it is important that you indentify yourself as a policyholder when you enter the hospital, so that whatever discount agreement we have with your insurance company may apply to your entire billing account.

The department’s staff members work for the Centro Médico Puerta de Hierro, not for any insurance company; ours is an administrative not a medical unit, and we make no determinations, nor do we issue any judgment in reference to insurance company determinations.

Hours

Monday to Friday from 7:00 a.m. to 7:00 p.m.
Saturdays and Sundays from 9:00 a.m. to  2:00 p.m.

Telephones
52 (33) 38.48.4005, 38.48.4006 and 38.48.4009