Introduction
Understanding the complexity of the healthcare system, this article aims to give you the information you need about a health insurance policy to maximize its use. If you have any questions, do not hesitate to contact me for personalized support.
Do I need to see a doctor? Where can I get care?
The method of care varies according to your needs. The ideal is to receive medical care within your insurer's provider network. Each company has agreements with different providers and specialists, which you can find on their websites:
The choice of a medical provider is at your discretion. Some may require a fixed payment or a percentage of the services rendered, so keep your policy's coverage in mind when seeking care.
I incurred medical expenses: how do I file a claim?
The copay is non-refundable. It's the amount established in your policy that you must pay for receiving the service. However, if you incur additional expenses or are prescribed medication, keep the following in mind:
- Always request fiscal invoices with your full name, ID number and date.
- When receiving a medical order (such as a medication prescription), verify that the doctor includes your name, ID number and the corresponding diagnosis code.
- Complete the claim form together with the medical service provider.
All insurers have agreed on a single claim form. I recommend printing it in case the provider does not have it available.
Claim submission methods by insurer
- ASSA: via the app or email (reclamossalud@assanet.com)
- Blue Cross and Blue Shield: email (reclamosalud@iseguros.com)
- Seguros Vivir: delivered in person, with follow-up by email (reclamos@segurosvivir.com.pa)
- WorldWide Medical Assurance: via the app or email (atencion_reclamos@wwmedicalassurance.com)
I need lab work or medical tests: how do I proceed?
The requirements depend on your policy. Some services do not require pre-authorization; usually pre-authorization is needed when expenses exceed $100. In all cases, you will need an order from your treating physician that includes the procedure with the diagnosis.
When pre-authorization is required, the treating physician will typically handle it for you, but in some cases you will need to manage it directly. Once authorized, you can go to the designated provider or to one of your preference. Remember to request fiscal invoices for reimbursement.
Pre-authorization contacts
- ASSA: beneficios@assanet.com
- Blue Cross and Blue Shield: preautorizaciones@iseguros.com
- Seguros Vivir: autorizacionesenlinea@segurosvivir.com.pa
- WorldWide Medical Assurance: via the app or preautorizaciones@wwmedicalassurance.com
I have an emergency: what do I do?
An emergency is a life-threatening situation that requires immediate medical attention. Don't hesitate to call an ambulance or seek care as soon as possible.
Most insurers cover emergencies at 100% without you having to pay for services, as long as you go to the emergency room for a detailed critical illness or an accident, and are treated by a provider within the network.
Important: make sure the reason you go to the emergency room is valid to avoid unexpected costs.
General recommendations
- Telemedicine: some insurers offer it with no copay — useful for receiving care without leaving home, with prescriptions and guidance on your consultations.
- Additional benefits: insurers have agreements with pharmacies, laboratories, optical shops and more, where you can access benefits or discounts. Find them in the app, website, or ask me.
- Reasonable use: a policy should not be used with the goal of "making a profit." High claim rates can impact the cost of your premium in the future.
- Expenses: always request a fiscal invoice with your name and ID number so you can file a claim.
- Medical orders: verify they contain your name, ID number and diagnosis code.
- Claims: file a claim for all expenses. If you don't receive a cash reimbursement, the expenses will be added to your deductible.
I reiterate my commitment to closely monitoring your health and well-being. Under any circumstance, do not hesitate to contact me. Confidentiality and mutual understanding between the insured and the broker will always be safeguarded.
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