A: Fortune CARE member may file a claim for reimbursement of expenses for covered emergency treatment/ hospitalization in a non-accredited hospital, or when the member had paid for charges incurred under covered services.

1.Claim must be filed within 10 days after the services or date of discharge.
2.Documents needed:

2.1 Request for Reimbursement Letter

2.2 Proof of confinement/service – Clinical Abstract or Discharge Summary signed by Attending Physician

2.3 Operative Records including histopathological record if surgery was performed.

2.4 Original Hospital receipts and Invoices both for Hospital Bill and Professional Fee.

2.5 Police or Incident Report for vehicular/ medico legal cases or accidental injuries.

3.Additional requirement for emergency hospitalization expenses in a foreign country:
- A certification from the Philippine Consulate that states all submitted documents are truthful and genuine.

Send to: FORTUNE MEDICARE INC.

Claims Department

3rd floor, Citystate Centre 709 Shaw Blvd., Pasig City

4.Fortune CARE will pay validated claims within 30 days after receiving the complete documents. In case the documents are incomplete, Fortune CARE will need additional time (less than 30 days) to process the claim once the documents have been completed.
5.Approved claims will be payable directly to the member or the PAYOR if the patient is a minor dependent. Once the claim has been reimbursed, Fortune CARE will no longer be obliged to pay for any liabilities related to the charges.
6.Receipt of payment of the claim discharges/ releases Fortune CARE from all obligations and liabilities related to the charge subject of the stated hospital and physician services.
7.Information on disapproved or reduced reimbursement claims will be conveyed to the member together with the reason for said action by Fortune CARE.
8.Where a claim for reimbursement has been denied, the member or his authorized representative may appeal the decision by filing a written request for reconsideration within 30 days from receipt of the denial stating new or additional information or reasons in support of said appeal.

A: The following documents are required in claiming your reimbursement of expenses:

CLAIMS REQUIREMENTS

I. REQUIREMENTS FOR DEATH CLAIMS
1.Death Certificate
2.Police Report if claim is accident related
3.Notarized Affidavit of the Claimant if death is due to illness
4.Proof of Relationship of Beneficiary
5.Certificate of Insurance/ Fortune CARE ID
6.Other documents to be required when necessary

II. FIRE ASSISTANCE CLAIM
1.Barangay Certificate
2.Certificate from the Bureau of Fire & Protection
3.Pictures of the Damaged House
4.Affidavit of Loss
5.Proof of Ownership
6.Certificate of Insurance
7.Other Documents to be required when necessary

III. MEDICAL REIMBURSEMENT FOR THIRD PARTY & WORK-RELATED ACCIDENTS
1.Police Report/ Affidavit of the Claimant
2.Medical Bills and receipts
3.Physician’s prescription
4.Certificate of Insurance
5.Employer’s Certificate (for work-related cases)
6.Other documents to be required when necessary

IV. DISABILITY CLAIMS
1.Police Report if claim is accident related
2.Notarized Affidavit of the Claimant if due to illness
3.Operating Room Record
4.Detailed clinical summary
5.Certificate of Insurance
6.Abstract or Discharge Summary indicating the functional level of the payor at the time of discharge or completion of treatment
7.Other documents to be required when necessary

V. OUT-PATIENT REIMBURSEMENT REQUIREMENTS
1.Request letter for reimbursement signed by the member/payor
2.Medical Certificate with indication of vital signs
3.Original copy of the official receipt/s
4.Referral slip by accredited Fortune CARE physician if referred to a non-Fortune CARE physician
5.Police report and Incident Report (For vehicular accident)
6.Result of Diagnostic Procedure done (MRI, CT-Scan, X-Ray, etc.)

VI. IN-PATIENT REIMBURSEMENT REQUIREMENTS
1.Request letter for reimbursement signed by the member/ payor.
2.Detailed Clinical Discharge Summary with indication of vital signs duly signed by the attending physician
3.Operative Record and Histopath Record (if Surgery was done)
4.Original copy of Official Receipt (For Hospital Bill & Doctor’s Fees)
5.Statement of account, charge slips and/or invoice
6.Pharmacist’s certification on non-availability of stocks with list of medicines bought outside or doctor’s prescription
7.Referral slip by accredited Fortune CARE physician if referred to a non-Fortune CARE physician
8.Police Report and Incident Report (For vehicular accident)
9.Result of Diagnostic Procedure done (MRI, CT-Scan, X-Ray, etc.)
10.Hospital’s certification of non-availability of room.