FV POLICY

1) “CASHLESS SERVICES” & DIRECT BILLING NETWORK

FV Hospital has signed a Direct Billing agreement (also called Third Party Agreement) with several insurance companies so that many services can be provided in a cashless way. If you are covered by an insurance company which is a member of our Direct Billing Network, this means that the hospital will claim to and receive funds directly from your insurance company, bringing you greater convenience and peace of mind.

As aforementioned, depending on the direct billing policy of a patient’s insurance provider, some insurers in FV’s network cover both outpatient and inpatient services, however many only cover inpatient services. In addition, every policy includes exclusions, deductibles, and limitations of coverage which must be analysed carefully as these may include some or all aspects of a patient’s treatment at FV. In the event that this occurs they will be responsible for paying for the charges which are not covered by their insurance provider. The following are potential examples of when this may happen:

  • If during further investigations, additional ailments are found which do not directly relate to the initial diagnosis on which the patient was admitted
  • If during a patient’s course of treatment, the doctor’s diagnosis changes from the initial diagnosis on which the patient was admitted
  • If it is discovered that the cause of the medical problem occurred prior to the start of the period of insurance cover
  • If some items (consumables or medications: vitamin, supplements) are expressly stated as ‘excluded’ in the insurance policy

All of these factors vary from one company and one policy to another, and FV Hospital’s insurance officers are on hand to assist patients in better understanding their policy. Please click here for the full list of the insurance companies that belong to the Direct Billing Network of FV Hospital.

Inpatient Services

When a patient is admitted to FV Hospital, FV’s insurance officers will contact their insurance provider before their admission to request a Guarantee of Payment (GOP). This can usually be obtained within 4 to 48 working hours after sending the required documents to the insurance company or to its administration representative (for example a broker company). However, and particularly in case of emergency admission, FV may have to ask the patient to make a deposit which will then be reimbursed to them upon to their request or at their discharge time once FV has received the GOP.

Usually the insurance company will send FV Hospital a GOP approving the hospitalisation up to a certain amount and/or certain duration, with specific exclusions in accordance with the patient’s policy. A second GOP may be necessary if the patient’s hospitalisation exceeds the amount approved or is longer than expected

If the patient’s insurer does not provide a GOP by the time they are to be discharged, they will have pay in full and then claim back the money from their insurer later. FV’s Insurance Office is on hand to guide patients through the claim process in this instance.

Outpatient Services

If a patient is visiting FV Hospital for a consultation or for other outpatient services, the billing procedure will depend on the type of card a patient holds and the scope of services (inpatient or outpatient) included in the direct billing agreement signed between FV Hospital and the patient’s insurer. Some insurers exclude outpatient services from direct billing agreements and some require that the patient co-pays. Essentially every policy is different and FV advises patients to read their policy carefully and check with their insurer, or contact FV Hospital Insurance Office should they require any clarification prior to consultation.

SOME MEMBERS OF FV’S DIRECT BILLING NETWORK 

Below are some examples of insurance companies with which FV Hospital has signed a direct billing agreement with. The complete list of insurance and assistance companies providing direct billing at FV can be found at here.

CFE (La Caisse des Français de l’Etranger) and « Mutuelles »

FV Hospital has signed a special agreement with CFE for inpatients whereby a fixed daily inpatient fee is applied for each category of hospitalisation; for example, medical, surgery, oncology, and so on. If a patient has CFE or “mutuelle” insurance like VYV International Assistance, April, etc., FV can instantly ascertain their insurance status by contacting their “mutuelle” insurance VYV, April, etc. to request for a Guarantee of Payment (GOP). FV Hospital asks that patients bring their CFE and “mutuelle” insurance details with them when undergoing treatment at FV Hospital. The deposit and fees they will pay will depend on the confirmation of their coverage from the insurance.

Please note that even if a patient is covered for outpatient care under their policy, FV Hospital is unable to offer cashless services for outpatient services and they must pay the charges and claim reimbursement from CFE. FV’s insurance office will provide support to prepare the documents necessary for their claim.

Henner-GMC

Once a patient becomes a Henner-GMC Membership card holder, they will gain access to the Henner-GMC medical network which includes FV Hospital. To benefit from the direct billing services they must present to the cashier their Direct Settlement Card or a MedProPass card together with a photo ID. Both Direct Settlement Card and MedProPass Card always indicate coverage rate and exclusions. The Direct Settlement Card can be printed directly from Henner-GMC website by following the actions below:

  • Go to www.henner.com
  • Click on “My personal space”
  • Log in using your username and password
  • Under “My medical networks”, click on “Download the Direct Settlement Card”.
  • Print out the card

Bao Viet Corporation 

Bao Viet and FV Hospital offer direct billing to those patients having Aon Premier Care & Bao Viet Gold Card cards. Online confirmation is however needed and is done by FV’s insurance officers; this process usually takes between 20 and 45 minutes to obtain.

FV Hospital has created an exclusive insurance policy with Bao Viet Corporation and FV Hospital providing inpatient insurance coverage for FV Hospital members. In case a Member cannot be covered because their medical condition is excluded from the insurance coverage, FV Hospital offers 15% discount (for Privilege Members) or 20% discount (for VIP Members) on hospitalisation fees.

In addition to the inpatient insurance coverage, members also enjoy unlimited free consultations and discounted fees on investigations undertaken at FV Hospital.

Life Insurance (Dai-ichi Life, AIA, Manulife, Prudential)

FV Hospital is pleased to provide direct billing for patients who are life insurance holders with healthcare insurance benefits for inpatient treatment. FV’s Insurance Officer will process online or contact patient’s insurer to obtain a Guarantee of Payment (GOP) for patient in case patient is indicated for inpatient treatment.

Japanese Insurers

If a patient is insured by one of the Japanese insurance companies that belong to FV’s Direct Billing Network (see list at the end of this brochure), we ask them to complete the relevant claim form, which can be found in FV’s Insurance Office before receiving cashless services. The availability of cashless services will depend on their policy.

Travel Medical Insurance provided by Assistance Companies

The list of Assistance companies with which FV Hospital has signed a direct billing agreement is given at here.

If, before their trip, a patient has secured medical coverage provided by an Assistance company they should provide FV Hospital all the documents related to their travel (i.e. flight tickets, passport with visa and insurance card/certificate) as well as details of their insurance policy, to enable FV Hospital to request a GOP from the Assistance Company.

It is useful if a patient takes part in the GOP process by directly calling their insurance provider’s hotline to inform them about their hospitalisation and press the insurer to issue a GOP.

Please note that when FV applies for a GOP prior to a patient’s treatment at the Hospital, FV often does not know the exact details of the care required so can only provide a patient’s insurer with a rough overview of their situation. During their admission FV will send a detailed breakdown of a patient’s current bill to their insurer. If any items on the breakdown fall under the exclusions of their policy and their insurer refuses to cover the cost, the patient will be responsible for paying the fees for those aspects of their treatment.

If, during treatment, it becomes apparent that the cost of the patient’s care is going to exceed the amount insured, FV will request an extended GOP from the patient’s insurer. While waiting for confirmation FV will ask the patient to pay an additional deposit. If the total cost of their treatment exceeds what is covered by the patient’s insurer, they will be responsible for paying the outstanding amount.

2) “CASHLESS” SERVICES FOR OTHER INSURANCE COMPANIES

Even when FV Hospital has not signed a Third Party Agreement with a patient’s insurance company, FV’s insurance officers will do their best to help patients benefit from cashless inpatient services by liaising with their insurance company or its administration representative. Direct billing is not possible for outpatient services when their insurance company is not part of FV Hospital Direct Billing Network.

When possible FV Hospital will request and accept a Guarantee of Payment (GOP) from insurers that are not part of FV Hospital’s Direct Billing Network. Once the GOP is obtained, which usually takes 1 to 3 working days, FV can provide inpatient services in a cashless way. However, and particularly in cases of emergency admission, FV may have to ask the patient to make a deposit which will then be reimbursed immediately to them once FV has received the GOP.

Usually a patient’s insurance company will send FV Hospital a GOP approving the hospitalisation up to a certain amount and/or to a certain duration, with specific exclusions in accordance with a patient’s policy. A second GOP may be necessary if their hospitalisation exceeds the amount approved or is longer than expected

FV cannot always request for a GOP, for example if the insurance company is based in a distant country with which the hospital has no existing relationship or legal recourse, such as Canada, Russia, Africa, Japan, etc. In such an instance, patients will be requested to pay a deposit, and then pay for the treatment costs incurred. Patients will also have to file a claim form with their insurer later. FV’s Insurance Office will be happy to guide and help all patients through this process.

3) NON-CASHLESS SERVICES

If a patient’s insurance company is not a member of FV Hospital’s Direct Billing Network they will be required to pay like any other patient for each service they receive. The FV Hospital Insurance Officer is pleased to help patients gather the documents required from their insurance company and complete the claim forms for them to be reimbursed.

French Social Security (la « sécurité sociale »)

If a patient is a French resident and is covered under France’s Social Security system, they will have to pay upfront and then submit invoices to their “caisse” in France.