Below you will find practical steps to follow the main procedures you may possibly need:
ACCREDITATION.
November 1st, 2002, a new accreditation system that uses magnetic identification cards, replaced the former system with conventional identification cards. 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.

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.

AUTHORIZATION.
Below, you will find a list of practices requiring previous authorization. This must be required via fax, by contacting us at 4018-8787 and 4018-8775. Remember that in all cases you need to provide a diagnosis specification or a presumptive diagnosis, indicated by a medical professional in his/her own prescription.
• Long term treatments
• Sessions
• Complex practices
• Hospital stays
• Specialized studies
• Glasses
• Contact lenses
• Shoe orthotics
• Prostheses (orthopedics)
• Removable dentures
• Orthodontic and orthopedic treatments (up to age 18)

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.

COMPLEX PRACTICES.
This kind of practices (studies, such as bone densitometry, MRI, brain mapping, polysomnography, normalized practices and others) shall require authorization. For this purpose, the medical order must be submitted to APSOT Medical Audit, together with a summary of the affiliate’s medical history.

HOSPITAL STAY.
The following procedure shall be followed in the case that hospital stay is required:
• The physician requiring hospital stay must certify it using his/her own prescription, stating diagnosis and required treatment.
• You or any family member must submit this requirement to APSOT administrative offices, receiving in exchange an Inpatient Order.
In case of emergencies, the affiliate shall be admitted for hospital stay by merely submitting his/her identification card and the physician prescription. Thereafter, he/she shall have 48 hours to submit the corresponding Inpatient Order to the medical institution. Potential non-covered expenses that may be incurred in (for example: guests, extra services, phone calls, disbursements for baby clothes in maternity services, etc.). Remember that such deposit or guarantee must be returned or rendered void after the inpatient discharge. At that moment, the incurred expenses will be deducted. If you or a family member were receiving inpatient care and want a guest to stay after regular visit hours, we recommend you to find out if the clinic charges a “guest fee", whether the bed is used or not. In such a case, this shall not be covered by APSOT. Remember that all the receipts issued by the providers at APSOT’s expense must be signed by the inpatient affiliate or by the closest responsible family member. Signing will imply that the undersigned person previously verified that the billed services were 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.

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.