HMO INFORMATION
Paete General Hospital works with accredited Health Maintenance Organizations (HMOs) and private insurance providers to help patients receive medical care with reduced out-of-pocket expenses.
Our staff will assist you in verifying your coverage and coordinating approval prior to consultation, laboratory tests, or admission when applicable.
WHO CAN USE HMO BENEFITS
You may avail HMO coverage if you are:
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An active cardholder of an accredited HMO
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A qualified dependent under the member’s plan
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Within the validity period of the membership
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Covered for the specific service requested
Coverage depends on your plan inclusions and your provider’s policies.
REQUIREMENTS
Please present the following upon arrival:
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HMO Card (original)
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Valid Government ID
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Authorization number or Letter of Authorization (LOA) if required
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Referral form (if required by your HMO)
Incomplete documents may delay approval or require temporary self-pay arrangement.
HOW THE HMO PROCESS WORKS
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Register at the reception and present your HMO card
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Our staff verifies your membership and benefits
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Approval or Letter of Authorization (LOA) is requested from your HMO provider
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Once approved, services will be performed according to coverage
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Non-covered charges will be explained before billing
Processing time depends on the HMO provider’s response.
SERVICES COMMONLY COVERED
Coverage varies per plan but may include:
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Doctor consultation
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Selected laboratory examinations
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Diagnostic procedures
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Emergency initial treatment
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Follow-up consultations (if approved)
Some services may require prior approval before they can be performed.
NON-COVERED OR PARTIAL COVERAGE
Patients may be responsible for charges not included in their plan, such as:
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Items exceeding coverage limits
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Non-accredited procedures
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Take-home medicines
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Additional requests not medically indicated
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Services without prior authorization
Our billing staff will explain any balance before discharge whenever possible.
IMPORTANT REMINDERS
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Always present your HMO card before receiving services
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Secure approval first when required by your provider
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Emergency cases may be treated first while approval is processed
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Coverage rules are determined by your HMO, not the hospital
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Failure to obtain authorization may result in self-pay billing
NEED ASSISTANCE?
Our admission and billing team is ready to coordinate directly with your HMO provider to make the process smooth and clear.
Please approach the reception desk for verification prior to consultation or procedures.