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HOW AND WHERE DO I SEE A DOCTOR: Direct Services -Home care -Hospital Stay -Outpatient practices
HOW DO I USE APSOT: Accreditation -Provision/hospital stay authorization -Referrals and Sessions -Long term treatments -
Specialized Studies -APSOT Direct Connection -High complexity practices -Paperwork filing

Important: ask the professional to be clear on the indications and possible diagnosis.
Remember that you must enter that data into directconnection to request authorizations.


Direct Services:

In order to receive care from a professional, select a physician from the directory of providers according to the corresponding specialty and preferred location. Call the doctor's office directly and schedule an appointment well in advance, identifying yourself as an APSOT affiliate. When you arrive for your appointment, you must submit your identification card and, upon requirement, a national identity document. The physician must fill out a form containing health care-related information and require you to sign it to give your consent for the service received.

Home Care:

If you are not able to go to the doctor's office and need to receive home care, you can make your request at the phone number 0800 666 2776. Clinicians, pediatricians or cardiologists must provide you with the corresponding services, according to your specific need. Response time shall not exceed 2 hours. When the physician goes to your home, you must submit your identification card. The professional must fill out a form containing health care-related information, which you must sign to give your consent.
Hospital Stay:

The following procedure shall be followed in the case that hospital stay is required:
• The physician who orders a hospital stay shall certify it using his/her own prescription, stating diagnosis and required treatment.
• You or a family member should load the hospital stay applications on: http://directconnection.apsot.com/ you will receive a Hospital Stay Order and print it.
In case of emergencies, the Affiliate shall be admitted for hospital stay upon mere submission of his/her identification card and physician prescription. The medical institution shall give the beneficiary 48 hours to submit the corresponding Inpatient Order. In all hospital stays, the medical assistance institution shall be able to require the Affiliate to make a previous deposit or to offer sufficient guarantee, to afford potential expenses that may not be covered (guests, extra services, phone calls, etc.). Such deposit or guarantee shall be returned or rendered void, respectively, at the time of discharge, after deducting those expenses that may have been incurred in. If a guest stays after regular visit hours, the clinic shall be able to charge a guest fee, whether the bed is used or not. For such purpose, Affiliates are recommended to find out the amount to pay, before making use of the service. If so, APSOT does not cover said service. All the receipts issued by the providers at APSOT expense shall be signed by the Affiliate or by the closest responsible family member. Signature implies previous verification that the billed services are real.
Stays in coronary care or intensive care units and clinical syndromes implying imminence of death or serious consequences shall be PROMPTLY communicated to APSOT. That way, we shall be able to better assist you in your decision-making process.
Outpatient practices:

Only those mentioned in the National Services Fee Scheduler are considered as such. These practices must be required by the physician who recommends them, using his/her prescription and indicating the corresponding code, even if he/she is the provider. No previous authorization shall be required for their provision. Enter directconnection.
Accreditation:

Whenever you or your affiliated family members go to a medical center or visit a professional from the directory of providers, you must submit the identification card, which certifies that you are a beneficiary of APSOT services.
Additional recommendations:
• Bring your national identity document, together with your magnetic identification card
• In case of lost or stolen identification cards, submit to APSOT the corresponding police report and require immediate replacement.
• If the provider cannot download the information from the magnetic stripe on your identification card, he/she must stamp on the paper forms the embossed information from your card using carbon paper, for a better control.

APSOT provides full coverage with contracted providers, on previous test of the patient and donor, hospital stay and surgery.

100% medication and disposable material.
100% professional team fees.
100% medication post - transplant (provided by APSOT).
Provision/hospital stay authorization:

If a provision requires authorization, you may get it through: directconnection, a new online service which allows authorizations online.

Referrals and Sessions:

If the provider recommends you a practice from another professional, he/she must indicate it using his/her own prescription, preferably including letterhead. He/She must also include the affiliate's information according to the identification card. Sometimes, APSOT professionals may decide to refer the patient to an advisor physician from the Health Maintenance Organization. In such a case, the adviser fees shall be paid by APSOT, provided that there is a written certification of the referral. If the physician recommends you a treatment consisting of several sessions, you must obtain the corresponding authorization from APSOT for the indicated session number. Whenever a session is completed, you must sign it to give your consent. This must remain in possession of the attending professional, so that he/she can then submit the documents together with the invoice.
Long term treatments:

If a condition requires a long term treatment, the affiliate must submit a prescription to the APSOT's administration, where the physician has stated, in his/her own, true and proper handwriting, that the purpose of such document is the prescribed long term treatment. Additionally, the professional must attach a brief medical history, where he/she has stated the diagnosis and expected treatment length. Remember that, upon submission, the issue date of the prescription must not be over 30 (thirty) days old. Upon submission of the prescription, APSOT shall issue an authorization to purchase the needed drugs periodically, until the prescribed treatment is completed or up to a maximum of 180 days. It is worth mentioning that in case that the affiliate requires financial support for comprehensive and long term treatments, the Board of Directors shall define the source and the potential amount to be supported in each particular case. For this purpose, it shall require information from both the affiliate and the attending providers.
Specialized Studies:

In case that you or a family member requires specialized studies (nuclear medicine, gamma camera, genetics, mammography, ultrasound scan, radio-Immune tests, CT scans, holter), this must be indicated by the physician using his/her own prescription, specifying presumptive diagnosis.
To request for the authorization for the test, enter to directconnection.

APSOT Direct Connection:

APSOT direct connection has two main sections: PROVIDER AND AFFILIATE, whether you wish to access to a medical Benefit or need to apply for an authorization, or if you are an APSOT affiliate and you need to authorize a medical provisions.


High complexity practices

This kind of practices (studies, such as bone densitometry, MRI, brain mapping, polysomnography, normalized practices and others) shall require authorization. For this purpose, we remained you that you should get your authorization online on APSOT: directconnection
Paperwork filing

_Family registration - Documentation: Standard documentation to be submitted to add non-primary holders.

DOWNLOAD
_PMI registration (documentation): :
_Pregnant: Medical Certificate (must indicate - possible due date)
_Newborn: birth certificate photocopy, photocopy ID (first and second sheet)
_Education Certificates: : The Affiliate with dependent children over 21 years and up to 25 years inclusive, who are attend school at official revenues or incorporated to the official education system, national, provincial or municipal and private institutions officially recognized, must submit the corresponding Certificate of Studies in order to continue using APSOT's coverage

Submit at:
* At 21
* Every year, at the beginning of school year









     
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