Medical Care Management

Either prior or at the time of admission, the insured party can preauthorise.

At the time of admission, the health provider asks for a preauthorisation.

At MCM, we receive notifications for emergency admissions on the next working day.

When the necessary diagnostic tests are completed, we receive an up to date report from the health provider regarding the clinical condition, the treatment plan as well as the possible length of stay.

Our MCM physician examines the received medical case report and, accordingly, issues an authorisation, or a cover note for the given length of stay.

In case of any ambiguities, we contact the treating physician for further clarifications.

At MCM, we usually obtain a follow-up report every two days, but if necessary more frequently, and a discharge note on the discharge day.

For services rendered other than the reasons of hospital admission, we inform the hospital that services might not be covered.

If during hospitalisation there is unclear medical information, our experienced medical controller carries an on-site assessment on behalf of the insurer.

If serious differences arise between the provider and MCM, we conduct an arbitration session, during which the treating doctor along with the provider justify the case management in question.

On the day of discharge, we receive the provider’s preliminary invoice regarding the hospital’s and the physicians’ fees.

Our team carries out both administrative and medical audits to secure the correctness of services and pricing.

After the pre-invoice clearance, we check and verify the final received invoices from the provider.

At the final invoice clearance, our team sends the invoices to the insurer for settlement.

We can answer FAQs concerning policies, rights and obligations.

Our MCM representative can inform you about preferred hospitals and ambulatory services.

We can provide useful information and guidance concerning services pricing and physicians’ fees.