HMO is an acronym for Health Maintenance Organization. It is a prepaid health care system that provides or arranges managed care for self-funded health care benefit plans, with the health care providers (hospitals, clinics, doctors, etc.). It provides a no cash-out feature for inpatient, outpatient and emergency cases within the limits of the HMO plan chosen. You will be given an HMO card that you can bring along and use in case of inpatient, outpatient and emergency cases to be availed through accredited providers only.

Inpatient means that the procedure requires the patient to be admitted to the hospital, primarily so that he or she can be closely monitored during the procedure and afterwards, during recovery. Emergency benefit includes treatment of emergency cases not leading to confinement. Outpatient means that the procedure does not require hospital admission and may also be performed outside the premises of a hospital.

HOW WE TAKE CARE OF OUR HMO CLIENTS

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    Sit down with client to determine what plans and benefits are needed by client.

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    Secure proposals from the different HMOs.

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    Submit proposals and provide a detailed comparison of benefits and rates from the different HMOs.

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    Sit down with client and HMO to fine-tune the plans and benefits to suit client needs.

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    Negotiate with the HMOs for the desired package and rates for the client.

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    Assist the client in deciding the best HMO and package

AFTER WE CHOOSE AN HMO

Our team will provide assistance and guide you with the necessary steps after we have chosen the HMO.
  • Secure master list from client and submit to HMO.
  • Follow up IDs; check each one to ensure correct data and to ensure timely delivery, and to check that each member was given an ID.
  • Follow up Billing, confirm for accuracy, and send to client.
  • Follow up payment to make sure that payment is remitted on time and that account is not lapsed and suspended.
  • Schedule orientation to ensure that the benefits, procedures and exclusions are understood by the members.
  • Deliver list of accredited clinics, hospitals, dentists, coordinators to client.
  • Follow up policy and check if the benefits, plans, and provisions stated therein are according to the agreement, and then submit to client for signature, send back to HMO and deliver signed and notarized to client.
  • Secure contact persons and contact numbers of HMO especially those needed for emergencies on a 24 hour basis.
  • Assign persons in our brokerage to handle clients’ questions, utilizations, queries and be available 24/7.
  • Act as liaison to receive Inclusion/Deletion lists from client and to forward the same to the HMO, and to follow-up new IDs, and collect cancelled IDs and ensure correct billing.
  • Get updates from HMO on any new procedures, new accredited clinics, hospitals, coordinators and inform client.
  • Schedule review of HMO with utilization report from HMO and submit to client for review and discussion.
  • Other requests of client.

PATIENT ASSISTANCE

IN-PATIENT ASSISTANCE

  • Upon member’s confinement, RAROCO’s 24/7 Hotline will be the one to monitor with the LIAISON officer of the HMO and will be the one to follow-up for the issuance of Letter of Authority (LOA) to have member discharged.
  • In case you want to upgrade your plan during confinement, patient can call the RAROCO 24hr Hotline. RARoco will explain to you the incremental costs involved.
  • The RARoco 24hr Hotline will remind the members to file his/her Philhealth form the moment he/she is confined in order to avoid having to pay the Philhealth portion of the confinement, and to avoid delays upon discharge.

OUT-PATIENT ASSISTANCE

  • If the members go to an accredited clinic or hospital without his/her ID, the RARoco 24hr hotline will be the one to coordinate with the said hospital or clinic so member can still avail.
  • For APE schedule, Roco Office will be the one to request the schedule and find a good clinic to conduct the APE.
  • If the clinic or hospital has a difficult time contacting the HMO for the approval code of the patient members, they can directly call Roco 24hr. hotline for assistance
  • Members can call Roco 24 hrs. Hotline for any suggestion or any inquires regarding their insurance coverage.
  • Some Clients/Members have pending unpaid bills with the HMO and the HMO automatically suspends coverage due to unpaid medical collectibles, Roco 24 hrs. Hotline will do something so that the HMO will give approval on the availment.
  • If members encounter some problems with the providers they can call RARoco 24 hrs. hotline to report the incident with the details. RARoco 24 hrs will promptly file a report with the said HMO so that the HMO can address the problem and to make sure that the same problem does not happen again.
  • RARoco 24 hrs. Hotline will schedule your Doctor’s appointment. You can call us for referral slips for physical therapy so you don’t have to go to the coordinator.
  • If your Doctor is not accredited with your HMO but has a clinic in the accredited hospital, Roco Office can act as liaison to have your doctor accredited with your HMO.

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