Guidelines of Cooperation for Third Party Payers – 03 December 2023
Health Guard Hungary® and SOSdoctors.HU® in cooperation with M.D. Assist OG provide premium level medical/dental services, assistance, advice and case handling to certain trustworthy Third Party Payers. We consider reliable assistance/insurance companies that can give a credible guarantee of payment for direct reimbursement. Our Guidelines of Cooperation intend to make our cooperation fast, effective and minimize the risk for errors. These guidelines must be accepted by the Requesting Party (you) before any services are ordered.
If you do not accept any portion of the following rules, then let us know before the services are requested. In such cases we reserve the right to decline any orders without giving further reasons.
Non-compliance with these rules may result in increased service fees without any further notice.
We (Health Guard Hungary) may periodically update our guidelines and will post it on our website.
It is your responsibility to check for the updated version at least once in the beginning of each year.
Medical Services or Assistance Requests – Process and General Rules
- Urgent Medical Services and Assistance must be requested in writing at all times via
email: [email protected]
or WhatsApp: https://healthguardhungary.com/whatsappqrcode/
- Confirmation by telephone may be made through the Central Operator:
+36 1 786-6658 or +36 30 6745457.
- For any services Essential details to be provided:
a) Full name of the patient (valid picture ID must be shown at the time of the services)
b) The patient’s date of birth
c) Brief description of the medical / dental problem, the reason for asking our assistance.
d) The level of urgency. State if you want a visit as soon as possible, within the next 2-3 hours or scheduled later at a certain time. You must specify the time frame when the patient will be available for the doctor visit. If you do not specify the time, then we assume it is an urgent visit, we will try to arrange it within 2-3 hours, and cancellation of such visits will be charged in full.
e) The party responsible for paying the cost of the visit. Let us know in advance in writing who will be responsible for the cost of the visit, the patient or you (name of Insurance covering).
f) List all exclusions from and any limitations of coverage in advance in writing.
g) If you cover the costs, but you do not list exclusions in advance, then we assume that you will pay in full for the visits in all cases, even if the current complaints are due to any pre-existent conditions, including but not limited to atrial fibrillation, asthma, atherosclerosis, diabetes, gallstones, heart failure, kidney stones, migraines, multiple sclerosis, venous insufficiency, etc.
h) State in advance, if you cover only the first visit or the related follow up care visits as well.
i) State in advance, if you do or do not cover the costs of additional or further care, that are deemed necessary by our doctors, such as special on-site testing (Rapid Urine test, CRP, Streptococcus test, Troponin-I test) or injections/tablets/sprays given by our doctor for the immediate treatment of the patient’s condition (such as IV/IM pain killers, antispasmodics, blood pressure lowering tablets, Aspirin PO, NTG SL spray), transportation by our vehicles to our hospitals, diagnostic imaging (Ultrasound, X-rays, CT-scan), labs, treatments such as splint placement, crutches, specialist consultations.
Please note! We accept trauma (any type of injury) cases only if X-rays and wound care with stitches are completely covered without the need for any further pre-authorization requests.
j) Reference number of the Requesting Party.
k) Name of the Insurance Company involved in the costs with the applicable policy number.
l) Name and contact information of the Requesting Party, contact person (telephone, email).
m) For office visit requests the exact name of city or town, with postal code.
n) For House Calls in private apartments or homes we need the exact location of the patient in writing from the Requesting Party: Name of Town (City), District Number or Postal Code, Street Name and Number, Floor (Level), Flat or Apartment Number, Doorbell (Intercom) Number, Name on Doorbell, or instructions how we can get into the building.
o) For Hotel Visits the exact Name of Hotel, Room number, Address, or Local Telephone number.
p) Make sure in advance that the patient speaks sufficient English or has a translator with him / her for the entire time of the doctor/dental visit. We expect that the patient will speak English sufficient enough for responsible medical / dental care. If – in our doctor’s judgment – the patient does not speak English (Hungarian) or does not have a translator then we may charge extra fees. These fees may be 90 EUR/30 min started if you do not notify us in advance about the need for a translator.
q) Request for Electronic and/or Paper records and Invoices. A File Fee will be charged for Paper records and Invoices, but waived if Electronic Records and Invoice are accepted without paper.
r) Billing address that needs to be printed on the invoice to the “Billed to” section.
s) Co-payment, Deductible with an Exact Amount, if any: If co-payment or deductible are not specified in advance in writing by an exact number, then we suppose there is no co-payment or deductible, we collect none, and we will charge our full service fees to the Requesting Party. We do not check the insurance policy for its existence, validity, co-payments or deductibles.
t) We always try, but may or may not be able to make and send you copies of the passport and insurance policy. Passport and Policy copying, validation, confirmation and providing us information about the limitation and exclusions of coverage, the exact amount of any co-payments or deductibles are the full responsibility of the Requesting Party.
u) As a rule, we will send you only our invoice and a medical report. We may accept and fill your medical report form provided in advance of the medical services, in lieu of our standard medical forms, but only one record will then be made and sent to you. We will not take responsibility for any additional statements, forms or any other paperwork or information exchange (e.g. confirmation telephone calls), that need to be filled or done by the patient or any related party. We expect full payment of our sent invoice based solely on the given medical report, either your or our standard form. Arranging any additional paperwork on our part is only optional and may be associated with extra charges and fees.
v) You must contact the patient and confirm that the patient will be at the given location at the proposed visit or transport pick up time. As our baseline policy, we will not call the patients to wonder about their whereabouts. It is the Requesting Party’s responsibility to provide us with an exact address and/or to inform the patient to be present in the given office / hotel room, apartment or flat. As a rule, we will not search for patients anywhere else, such as in the hotel lobby area, in other rooms, in the restaurant or around the swimming pool. We reserve the right to increase our visit fees by 30 EUR if the requesting party provides false or inaccurate information about the patient, and we have to perform extra search to localize the patient (such as inaccurate name, address, hotel room number). We also charge you if the patient is not available in time. The doctor or transport driver will wait 15-30 minutes for the patient and then leaves if the patient did not show up or we did not get instructions from you to wait more. Late fees applied: 30 EUR / each 15 minute period started.
w) Repeated service requests for or communication about the same case via email must include all of our prior correspondence using the “Reply” function. If we receive email messages from you without including the prior information exchange (emails) regarding the same case as described above, then our services may become slower and we charge a basic additional administrative fee of 30 EUR/ each occasion for this excessive administrative burden for keeping track of the events. Weekend, evening, night, holiday and other surcharges may also apply.
x) Appointments are valid only for the specific location (our network provider), the given date and time. When we give an appointment at any of our providers based on your request, then you cannot send the patient back or to any of our providers at another time for any services even with self-arrangements or self-payments. You are not allowed to send self-payer patients to any of our providers without the patient calling us directly and having an appointment approved in advance. You must communicate with us about any patient referrals, even with self-payments. We may accept the patient at our own terms in such cases and will so inform you and the patient. We may increase our future service prices toward you if you send patients to any of our providers that were unauthorized by us.
y) Please note that we may not send you courtesy e-mails clarifying the differences between a hospital, an outpatient office/ambulatory and a house call visit. You must realize and accept that there are significant price and waiting time differences if the client is evaluated in the hospital contrary to the outpatient office or at home. We will start making arrangement for the requested services as soon as we receive your written or telephone request and we will charge our full visit fee for no-shows and cancellations. This includes hospital no-shows, even if the patient cannot tolerate a possibly 12 hour waiting time on site. If you request a hospital visit, then in case of no-show or cancellation our full basic fee for a hospital visit will be charged to you. We can always organize a hospital visit. The basic visit fee in the hospital is much higher than the fees for an Office Visit or House Call. The expected waiting time before the client is going to be evaluated by a doctor in the hospital – depending of the severity of the patient’s condition in the hospital staff’s judgment – can be anywhere from 1 hour to 12 hours. The hospital visit basic fee does not include the additional hospital charges that are generally much higher than the charges with house call or office visits. Lab work, radiology work up, additional specialist consultations often times must be done in hospitals, which further increase total charges. Outpatient Medical Office visit arrangements are scheduled at fixed appointment time, without waiting. Visit fees are much less for these services compared to hospital fees. House calls are also available. Our doctors can always evaluate your client at his home and arrange an Ambulance and Hospitalization if medically necessary. Generally speaking, we advise house calls/office visits as the first step to properly evaluate further medical service needs. We may provide you with an option to change a requested Hospital Visit for an Outpatient Office visit at our sole discretion for an additional fee, if you change your mind after the scheduling was made.
z) If you do not specify in your original service request the type of visit wanted – e.g Hospital, Outpatient Office, or House Call – or you do not provide an exact address of the patient, then by default we will schedule an Outpatient Medical Office visit. We will not make telephone calls to the patient to clarify their exact location for an intended House Call.
Dental Services and Assistance Requests – Process and Special Rules
- Dental Services and Assistance must be requested the same way as Medical Assistance – See 1.
- For any services Essential details to be provided:
a) The patient’s data: Last name, First name – Date of Birth
b) What is the exact nature of the dental problem and complaint?
c) Who will pay for the services, the patient or you?
d) If you pay for it, then you must specify the exact extent of coverage for the dental problem.
e) Will you cover all dental services for the teeth? Dental urgency only? Dental trauma only? Pain control only? Incision and draining of an abscess? General dentistry? Loose or fallen filling? Loose crown or implant? Building a new crown or place a new implant?
f) Is there an upper limit for the dental services? Is there any co-payment or any deductible? If you do not provide us exact numerical information about the upper limit of coverage, the co-payment or deductible, then we suppose there are not any.
g) You must first provide us with the time frames when the patient is able to come for a dental visit. Only then will we try to give you an appointment, if we can, in that time-frame. If we give an appointment time for one of the time frames you first requested, then later there may be no possibility to change it for free, but only for additional fees, which may be the full cancellation fee of 80-140 EUR. Weekend evening, night, urgency and countryside fees also apply. We will not try to adjust our dentist time back and forth, open a desired time spot for any patients, who think they may later simply cancel or change at their own will.
h) When we give an appointment time, then that is considered final on our part and the patient is expected to show up in time. Changes may not be allowed at all or only for additional fees.
i) If we schedule an appointment and the patient does not show up, then we charge you 80-140 EUR, our non-refundable no-show fee for dental services. You must tell us in advance who will pay this fee. We do not schedule a visit until we know in advance who will pay the no show or cancellation fees. Pre-payment is expected if the patient is responsible for this.
j) If we schedule a visit based on your request, then you are the responsible payer, and we will charge 80-140 EUR even if the visit is later cancelled at any time for any reason.
k) English is spoken by our dental surgeons. Clear and immediate communication is essential in dental care. If the patient cannot communicate in English (or Hungarian), then the patient or you must provide a translator, who must be physically present throughout the entire visit in the dental office. We may be able to provide a translator in other languages but you have to request this service in advance in writing, and an extra fee will be charged for this. For cancellations and no shows in such cases the requested translator fees will be charged to you as well.
Execution of Medical & Dental Services and Assistance
- We make all possible efforts to attend the patients (insured clients) with great care, in a timely fashion and professional manner at all times. However, we cannot guarantee complete or immediate coverage in all regions across Hungary. Please note that access to care especially in remote regions in the countryside may be slower or sometimes not available at all. For urgent service requests we will give you a response and appointment time as soon as possible. We consider all service requests urgent, unless you ask for an appointment at a certain time in advance. We charge for no shows, cancellations and lateness.
- The patient must show a valid picture identification document (e.g. passport, driver license, national ID card) at the time of the services. Without proper identification we may decline the provision of services but will still charge our full visit fees to the requesting party.
- Feedback will be provided to and pre-authorization will be asked from the Requesting Party as soon as possible, if extension of the medical/dental services is deemed to be necessary by our physicians or dentists, such as needs for additional Diagnostic Studies (laboratory, imaging), specialty consultations or treatments. This generally means that a second appointment or visit is needed. We charge additional fees if for such services further approval is urgently needed.
Exceptions, when we may not ask further pre-authorization are diagnostic imaging or procedures when they are part of the usual and customary workup to achieve initial diagnosis as well as certain treatments, delay of which may create significant risk to the patient’s health or life in our physician’s judgment. Examples include but are not limited to: Dental X-rays; Clinic/Hospital X-rays of injured or painful regions; wound care with or without sutures; CT scan of the head in Clinic/Hospital when injury, headaches or other neurological symptoms indicate it; Chest X-ray and EKG in Clinic/Hospital in case of respiratory or cardiac symptoms; Rapid Troponin blood test in case of cardiac symptoms; Urine Analysis (rapid dipstick) in case of urinary symptoms, Rapid Strep A testing in case of sore throat; Rapid CRP testing in case of suspected Sepsis; Abdominal and Pelvic Ultrasound and Laboratories in Clinic/Hospital in case of abdominal pain, distension, vomiting; Injections to treat arrhythmias, shortness of breath, heart failure (morphine, diuretics, lidocaine, atropine, adrenaline), acute asthma attack (bronchodilator, steroids), suspected anaphylaxis (antihistamine, adrenaline, steroids); Procedure to remove debris from external ear canal(s) to allow proper examination of tympanic membranes, if reason for the visit was an ear problem or one of the related complaints involve the ear(s). You are responsible for all these charges above.
- Original Medical & Dental Reports and Invoices with our letterhead and logo in unalterable digitally signed and stamped pdf formats that are printable, will be available for download form our data server within five workdays. Surcharges may apply, if you cannot download your requested documents from our password protected well-functioning on-line link, because of security/IT issues on your side, and we need to individually lock (password protect) and send documents.
- Paper records will be mailed only if specifically requested. In such cases our additional Paper File Fee will be charged to the Requesting Party as well.
Expected Payment Terms and Conditions
- An Assistance Fee will be charged each time a case gets open, based on verbal (telephone) or written (email) requests, even if the services will later be cancelled at any time for any reason. We charge our full fees for no shows and cancellations of any services, including but not limited to doctor office visits, house calls, assistance / advice requests as well as any case handling.
- The Assistance Fee may be charged separately by one our Assistance Partner Companies (e.g. M.D. Assist Og. in Austria) to the Requesting Party.
- If an arranged Medical Specialist or Diagnostic Study service is cancelled more than 3 full business days before the set time of the patient-doctor encounter / study, then only the Assistance Fees may be charged to the Requesting Party. If such services are cancelled less than 3 full business days before the set time of the patient-doctor encounter / study, or the patient does not show up or not ready for transport as scheduled, then our full Assistance and Medical Service Fees will be charged to the Requesting Party.
- If a House Call or Urgent Office Visit request is cancelled more than 180 minutes before the set time of the patient-doctor encounter, then only the Assistance Fee may be charged to the Requesting Party. If such a service request is cancelled less than 180 minutes before the set time of the patient-doctor encounter, then our full Assistance and Medical Service Fees will be charged to the Requesting Party.
- If we cannot identify the patient at the location specified in the house call (home or hotel visit) service request, or the patient is not ready for transport as scheduled, then our full prices will be charged. Late fees applied: 60 EUR / each 15 minute period started. The doctor / driver will wait 15-30 minutes for the patient and then leaves if the patient is not present or we did not get instructions from you to wait more. We are applying the late fees from the given appointment time, from the time our doctor arrived at the given site, or the given transport pick up time.
- The additional Paper File Fee will be waived for the cancelled service or no show cases, only if electronic records and billing for such cancelled services are accepted by you via email attachments. Regardless, the full Assistance and Medical Service Fees will be charged for such cancellations or no shows.
- Our current price list of most services for Third Party Payers will be available on our website: http://healthguardhungary.com/insurance. Both Medical and Assistance fees apply to Third Party Payers. If your desired services are not listed, then you must ask.
- We will provide you detailed invoices with the patients’ data and the diagnoses in English.
- Banking details for wire transfer will be included on the invoice with a payment deadline. Bank account numbers may vary according to different providers from our network. It is your responsibility to make sure that the bank transfer is directed to the bank account given on our invoice. Faulty payments may incur surcharges for corrective actions on our part.
- During bank wire transfer payments to us you must cover all banking costs (including but not limited to any transfer/intermediate banking fees) and the Invoice Reference number must be included with the payment in the subject field. 30 EUR/transfer surcharge apply if the Reference Number is not given, as it causes extra administrative burden on us to find out what is being paid.
- If we do not receive full reimbursements by the due date, that may be 15-30 days from the date of our invoice, then upon our written email notice we may introduce co-payments to the clients, and/or suspend accepting service requests with coverage confirmation from such delinquent Third Party Payers (such as insurance or assistance companies). From that time we may continue providing medical & dental services upon requests, but we reserve the right to charge the patients directly. Thus we may collect service fees from the clients of delinquent Third Party Payers at the time the services are rendered or requested. Medical & Dental records and invoices will be given to such clients upon their payments according to our terms herein.
- Based on the initial or repeated service requests – regarding the described medical condition(s), patients’ complaints, and/or the reason given to us to attend the patient – we expect full payment from the Third Party Payer for all requested patient-doctor visits (initial and/or follow up examinations) at least up to the point to reach – the often times only suspected – diagnosis. You must pay all requested doctor visits and tests, even if the suspected and/or later diagnosed – possibly pre-existent – condition is generally not covered under the policy of the Third Party Payer (for example: asthma, injuries due to fight or violence, tooth caries, chronic pancreatitis, gallstones, kidney stones, normal or tubal pregnancy, miscarriage, tumors, complications of cancer, autoimmune diseases, sexually transmitted diseases, etc.). In such cases we may try to collect payment from the patients directly, but only if the full payment is received from the patient shall we release the Third Party Payer’s obligation to cover our costs for its requested services. It is the sole responsibility of the Requesting Party to decide about ordering services / offering us guarantee of payments for suspicious conditions / complaints that may possibly indicate or be associated with diseases that are excluded from the policy’s coverage.
- For any party, who expects us to include alcohol/drug testing in the medical report or has alcohol/drug testing on their standard forms sent to us, we charge a significant extra fee for each and every case – regardless of the patients’ age, medical conditions and the presenting complaints. We consider such parties high risk payers, as they may refuse to pay our visit fees in case the patient was intoxicated or if the paperwork was incomplete. If you have alcohol/drug testing on your standardized forms, but you do not need the testing in the particular case, then you must specify that to us in writing in advance. If you insist on performing alcohol/drug testing – by physical exam, breath test or laboratory – then we start examining the patient only after our visit fee was paid either by you or the patient (his/her representative) in advance (cash, on-line credit card, PayPal payments are available).
- We reserve the right to increase our usual and customary prices by 30 – 100 EUR for delinquent payers (second or third party) without any further notice. We consider a payer delinquent if they have an unsettled balance for more than 60 days after the receipt of our invoice. Certain extenuating circumstances may be given consideration if properly requested in writing. We also reserve the right to add the unpaid balance to the next service orders’ charges in part or in full.
- We believe that our prices are reasonable and customary taking into consideration the level and quality of our services in regards to speed, accuracy, professional competence and communication skills. After the requested services were done, you may not refuse payment to us based on your retrospective review and audit stating that our charges were not “reasonable, usual and customary” or “higher than the prices of other local providers”. You may possibly negotiate about our prices and fees only in advance before the services are rendered.
- If you send us a Guarantee of Payment or any service request, then you are the financially responsible party. We do not accept such excuses that you (as an assistance company) are only acting on behalf of your client, another third party payer, such as an insurance company. The Requesting Party is responsible for the full payment to the same extent as any of his clients.
- As a rule, we do not transfer to you any receipts, invoices or any other documents from our partners, supporters, subcontractors, subsidiaries, suppliers or any agents that we cooperate with for any type of services. We provide the medical and/or assistance services ourselves within our organization and issue the invoice to you without listing or proving our costs or expenses in any matter. We do not handle over to you the receipts we paid to any party.
- In certain cases, we may ask you to make pre-payment and reserve the right not to perform certain services without financial security deposits.
- In certain cases, we may ask you to give us your bankcard to secure payments for our services. By giving your bankcard details you entitle us to charge any and all services we performed, including late / wait fees as well as cancellation / no show / rescheduling fees.
- You have no right to recover any fees paid to us, unless We fail to provide the promised services.