If emergency, proceed directly to emergency room or call
ValuCare Customer Service Hotline (02-702-3310) for immediate endorsement to emergency room personnel. If non-emergency, call ValuCare Customer Service Hotline (02-702-3310) for the following assistance:
• ValuCarewill endorse plan holder to appropriate accredited doctor within the hospital.
• ValuCarewill provide other necessary documents as required by accredited hospital.
• ValuCarewill refer member to nearest accredited clinic/hospital if no appropriate accredited doctor available within the hospital.
There are no available doctors in the hospital for out-patient healthcare services during Sundays except those in emergency room (even on Saturdays, most doctors are on half-day schedule). Call ValuCare Customer Service Hotline (02-702-3310) for assistance.
• ValuCare will refer Planholder to the nearest accredited clinic.
• Doctors on our accredited clinics are available during Sundays,especially those inside malls. They have doctors with different specializations which make them ideal provider for out-patient healthcare service (non-emergency) during weekend; being inside the mall is also an added convenience.
• The case will not be covered since it is included in the Exclusions & Limitations: Service from Non- ValuCare Accredited Physicians and / or Non- ValuCare Accredited Hospitals and other health / medical providers, including adverse medical conditions arising from treatment of the same except those stipulated under the provisions on emergency care services.
• If client has Point of Service provision, the applicable expenses will be reimbursed following ValuCare reimbursement procedures.
• If ValuCare does not have accredited specialist doctor appropriate for the member’s case within the accredited hospital, hospital bills will be covered by ValuCare and Professional Fee will be on a reimbursement basis (subject to MCB, Exclusions & Limitations, and ValuCare reimbursement procedures).
• The case will not be covered since it is included in the Exclusions & Limitations: Service from Non- ValuCare Accredited Physicians and / or Non- ValuCare Accredited Hospitals and other health / medical providers, including adverse medical conditions arising from treatment of the same except those stipulated under the provisions on emergency care services.
• If client has Point of Service provision, the applicable expenses will be reimbursed following ValuCare reimbursement procedures.
• If ValuCare does not have accredited specialist doctor appropriate for the member’s case within the accredited hospital, hospital bills will be covered by ValuCare and Professional Fee will be on a reimbursement basis (subject to MCB, Exclusions & Limitations, and ValuCare reimbursement procedures).
• Call ValuCare Customer Service Hotline (02-702-3310) for assistance in transferring to accredited hospital, if medically possible (for admitted case).
• If case is an emergency, ValuCare will reimburse it subject to pre-existing condition coverage, exclusions & limitations, and reimbursement procedures of ValuCare .
• If non-emergency, ValuCare will not cover the case.
• For confinement, ValuCare Hospital Liaison Officer will visit admitted member for assistance within 24 hours of confinement (contact member if in provincial areas) to explain nature of the case. ValuCare coverage is based on the diagnosis given by the accredited doctor.
• ValuCare will not cover the case until no established diagnosis has been given by the attending accredited doctor.
• If the confinement has been paid by the member. But, the final diagnosis can be covered by the program; ValueCare will reimburse 100% of applicable hospital bills androfessional fees based on ValuCare Relative Value Unit and subject to ValuCare reimbursement procedures.
• Value Care as much as possible, will advise the member that it is not appropriate on medical practice to have two doctors of same specialty managing his case at the same time.
• If member insists, he has to pay the professional fee of the non-accredited doctor.
• ValuCare will only cover prescriptions made by the accredited doctor.