General Rule:
For LOA requests involving laboratory tests and procedures, the member is required to submit a copy of the doctor’s request indicating the exact amount for each procedure prior to LOA issuance. However, if the LOA request is made through the AMAPHIL mobile app , via email from the member, or through our viber group chat with Polaris team , there is no need to request the exact amount, as it will be based on SLMC rates. For AllAccess requests, you only need to provide a screenshot from the system showing the diagnosis, procedures, and corresponding amounts, which will serve as the supporting document to be attached in CBMS.
All approval requests with amount of Php5,000 and above is required to be encoded in Polaris CBMS.
All approval requests with amount of Php15,000 and above is required to seek approval first of the Polaris team before we can issue LOA.
OPD-OR availment are deductible in outpatient limit.
Admission Requirements:
Admission report or Admission order
Laboratory results if available
Inpatient Discharge Requirements:
Medical abstract or Medical certificate with the attending physician's signature
Summary of Account (SOA)
Itemized charges
Laboratory results
OR-tech (if applicable)
PF should be indicated in the SOA
Discharge Schedule: Monday to Friday up to 6pm only; Saturday up to 2pm only; Sunday no discharge allowed
Click here to download the computation sheet of Polaris.
For Discharge Approval:
Please send only one email at a time, ensuring it contains all the necessary details and attachments.
Ensure that all attachments are labeled clearly.
The following documents are required for approval:
Medical Certificate/Abstract/Discharge Note (must include the final diagnosis and the doctor’s signature. For the Discharge Order, the disposition of the patient upon discharge must be included)
Statement of Account (SOA)
Approval Template
Additional documents as requested (e.g., Patient data, laboratory results, etc. As per the approver’s instructions, Medical Officers may send the Medical Certificate/Abstract, SOA, and Approval Template initially for computation.)
Send the approval to the following email addresses:
Coo <coo@polaris-finance.com>
Mnalupano <support@polaris-finance.com>
Info <info@polaris-finance.com>
xguirao@polaris-finance.com
SDucay <helpline@polaris-finance.com>
For OPD-OR Approval:
Approval is required for amounts of 15,000 and above.
Please send only one email at a time with complete details and an attachment.
Ensure that the attachment is labeled appropriately.
The following document is required for approval:
- Doctor’s request (must include the final diagnosis and the doctor’s signature)
Send the approval to the following email addresses:
Coo <coo@polaris-finance.com>
Mnalupano <support@polaris-finance.com>
Info <info@polaris-finance.com>
xguirao@polaris-finance.com
SDucay <helpline@polaris-finance.com>
DETAILS TO ASK TO THE PROVIDER DURING LOA REQUEST
Please provide the following details:
Last consultation (date)
Name of doctor on last consult
Medications
Itemized price of lab tests
Copy of doctor's request
RULES AND GUIDELINES IN LOA APPROVAL
Request for coverage must come from accredited physician with valid loa for consult (members cannot request for procedures on their own)
Do not approve requests for lab/diagnostic procedures without this or from non-accredited doctors
No approval for non-accredited but accepting physicians
No requests for approval for loa ordered for laboratory/diagnostic procedures withour prior consultation with the accredited physician
If md is accredited but the patient did not pass thru our process (ie loa facilitated consult) and paid the pf, then did not pass thru our system and there should be no approval for the request for lab or diagnostic
No approval for previous requests for lab/dianostic procedures from md when the patient was still with another hmo (requested when the member was still with former hmo)
Re-assess request that were ordered more than 2 months ago (request must be current)
ADDITIONAL REQUIREMENT:
Request a copy of the doctor's request and the exact amount or each procedure.
REQUEST APPROVAL FORMAT
Member's Name:
Age:
Gender:
Company Name:
Facility:
Requesting Doctor's Name:
Doctor's Specialization:
Date of Consultation with the Requesting Doctor:
Prior Consult Chief Complaint:
Diagnosis:
Note: If it is an existing Chronic Disease/PEC, since when that member was diagnosed with this and what were his/her medications:
Requested Tests:
Incurred Utilization:
PEC limit/MBL per illness:
Plan Category:
ROOM AND BOARD UPGRADE PROVISION
Request Certificate of isolation and/or certificate of room non-availability for the application of room waiving.
PROVISION ON INCREMENTAL CHARGES
(Rate of room occupied – room and board plan benefit) x (no. of days confined)
Plus 25% of net hospital bills if upgrading one (1) level: Ward to Semi-Private
Plus 35% of the net hospital bills two (2) levels: Ward to Private
(Not applicable for Suite room upgrade) - meaning whole confinement is not covered
https://docs.google.com/spreadsheets/d/15x1vnz60khhdbktRtjeAKVTGKw8mr4ukrBpDrEG4_oY/edit?gid=0#gid=0
PROVIDED LIST OF PEC:
Tumor/Cyst of Internal Organs
Hemorrhoids/Anal Fistula
Diseased tonsils and sinus conditions requiring surgery
Cataract/Glaucoma
Pathological Abnormalities of nasal septum or turbinates
Goiter and other thyroid disorders
Hernia/Benign Prostatic Hypertrophy
Endometriosis
Asthma/Chronic Obstructive Lung disease
Epilepsy
Spinal column abnormalities
Tuberculosis
Cholecystitis
Gastric or Duodenal ulcer
Hallux valgus
Hypertension and other Cardiovascular diseases
Calculi of the urinary system
Tumors/Cyst on skin, muscular tissue, bone or any form of blood dyscracias
Diabetes Mellitus
Cerebrovascular Accident/Transient Ischemic Attack
ENT conditions requiring surgery
migraine
cirrhosis of the liver / fatty liver
cholelithiasis
All availment amounting Php10,000 and above need to have approval from paramount before issuing loa (please email to paramount for documentation).
ROOM AND BOARD UPGRADE PROVISION
Request Certificate of isolation and/or certificate of room non-availability for the application of room waiving.
PROVISION ON INCREMENTAL CHARGES
35% incremental charges
INPATIENT PF COMPUTATION
PF counting is the same with room and board counting (start counting the day after admission).
Computation Sheet needs to be accomplished and send to Paramount team upon request of approval in their end.
Click here to download the computation sheet.
Email Address of the Paramount approvers:
catalina.pamiroyan@paramount.com.ph
naome.lucernas@paramount.com.ph
ACCIDENT AVAILMENT REQUIREMENTS
Upon admission to ER, required to send incident report (IR), POLICE REPORT, OR-CR, DRIVER'S LICENSE
If the patient cannot provide all the requirements, he/she needs to send us a copy of signed waiver.
REMINDERS:
Incident report is required for all animal bite or scratch cases, regardless of the type of availment.
Incident report is also required for any trauma-related diagnoses, regardless of availment type.
Stabilization fees are not covered (as indicated in the list of non-covered items).
Always request the actual itemized billing for all emergency room (ER) cases.
For Paramount accounts involving MRI or CT scan, coverage is plain only, unless otherwise specified in the Schedule of Benefits (SOB).
Chief complaint of blurred vision is not covered.
Tension headache is not covered.
Physical therapy coverage is limited to basic PT sessions only.
Save a copy of the Paramount approval using the file naming format: TRN_LOA_MEMBER NAME.
https://drive.google.com/drive/folders/1PlhN1fu1vKxPjMMFbCObXdJu0EJE2ep2
All accounts, except MIFFI, have access to all coverages except OPLab.
MIFFI accounts have access to all coverages, including OPLab.
For OPLab availment under non-MIFFI accounts, contact RMC2 at 0939-337-4037 or 0919-081-8232, or by scanning the QR code printed on their card.