Providing care is the business of Maxicare. The best service is the service you receive at the time you need it most – this is where we excel. Find the details below on specific availment features that are available when it really counts. This section also details the Claims procedures to make sure we get to process your application promptly.
An emergency condition shall mean the sudden and unexpected onset of illness or injury which, at the time of occurrence, reasonably appears to have the potential of causing disability or death, or which requires immediate alleviation of severe pain and discomfort. These illnesses or injuries require urgent medical or surgical care which the enrollee secures immediately after the onset or as soon as the care may be made available but, in any case, no later than 24 hours after the onset. Heart attacks, cardiovascular accidents, poisonings, loss of consciousness or respiration and convulsions are examples of emergency conditions.
For such conditions, Member may proceed to the emergency room of the nearest hospital or clinic whether accredited or non-accredited.
1. Maxicare-Affiliated Hospitals
2. Non Maxicare-Affiliated Hospitals
In an emergency confinement where Member’s room entitlement is not available, room upgrading is allowed. However, upgrading is applied only to the next higher room accommodation. In this case, Member will not shoulder the excess charges, i.e., the room rate difference and incremental costs on the first 24 hours from actual time of confinement.
On the other hand, should room upgrading extend beyond specified period, all excess charges will be under Member’s accountability and should be settled directly with the hospital’s Billing Section upon hospital discharge.
– Maxicare Retainer Physician at Company Sites
– Maxicare Primary Care Physician at any Maxicare Primary Care Center
– Maxicare Coordinator at any Maxicare-accredited hospital or clinic
If member’s medical condition requires consultation with another specialist, appropriate referral will be made by the Maxicare Retainer Physician, Coordinator or Customer Care Representative.
– Copy of Admitting History from the hospital’s medical record
– Copy of clinical abstract duly signed by the attending physician
– Original receipts of hospital bills
– Original receipt of professional fees
– Original copy of hospital’s statement of account
– Original copy of charged slips or itemized breakdown of charges per cost center.
– Operative record and histopathological report if surgical intervention was performed
– Other documents or proofs which are necessary to support the reimbursement