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* FAQ section has been updated * *
1- I am traveling and I need to know if my plan covers
me.
R- If you are traveling to the United States or other
countries outside of
Panama; your plan covers medical emergencies reported within 48 hours
with a (co-pay of $ 5.00). It covers
accidents reported within 72 hours (NO
CO-PAYMENT).
Medical Emergencies are defined under
Section 5 in your plan brochure. If you are under POS – the plan covers you 100%
of POS benefits. If you have the FFS
plan – you pay, and the plan will reimburse you
50% of the reasonable and customary rate.
The medical services received during a
trip out of the service area with conditions not severe enough to be classified
as emergency cases will be reimbursed under the FFS benefits.
2- When traveling to any country outside of Panama and
need to buy prescription drugs, How is it managed?
R- When you travel to any country outside of Panama, you must purchase the
medications and file the claim to AXA ASSISTANCE,
P.O. Box
31-0940, Miami, Florida 33231-0940.
3- If I am traveling to the United States or any country
outside of Panama, which doctor or hospital I can go to?
R- When traveling to any country outside of Panama, the members can go to
any doctor or hospital. The providers are not contracted therefore they do not
have to accept the Panama Canal Area
Benefit Plan. This may require you to pay for your services and submit your
claims to the U.S. to process. If you
are over 65, it would be of your best
interest to choose a participating Provider with Medicare, and your claim in
the United States would be reimbursed according to Medicare rates.
4- Could you please confirm how many visits a year I
have with the Gynecologist?
R- Under the
preventive care benefit, you are entitled to 1 visit to your gynecologist,
without referral and without co-payment.
5- How can
I obtain my hearing aid?
R-You need
to visit your Primary Care Physician (PCP) to obtain a referral for the specialist
(ENT-otorhinolaryngologist) you will be required to have a hearing test done, then
send the results of the hearing screening along with the PRE-AUTHORIZATION form to AXA
–Assistance for the proper approval. Once you obtain the approval you must
take the approved PRE-AUTHORIZATION to Dr. Guillermo Rodriguez’s office at Clinica San Fernando,
you are required to pay the co-payment of $ 5.00 dollars to obtain the device.
6- What does my health insurance cover on dental
procedures?
R- Maintenance of Oral Prophylaxis limited to two (2) visits per year. Dental
Surgery, Dental Periodontics, Endodontics, prior to these treatments you are required to
submit a complete estimate on the Dental
Treatment form to obtain approval for the treatment of
these benefits.
If approval is not obtained, we will limit benefits to 50% of the fee
schedule.
7. Would
you please provide information on prescription drugs and pharmacy?
R- For your convenience, we have integrated Farmacia El Javillo as a participating provider for your
medication needs. To obtain this
service, you must submit the following:
- · Submit a current
medical prescription with the date, name and a details of the medication.
- · Complete a HCFA 1500
form. The pharmacy will offer a pensioner discount of 20% established by the
Panamanian government, and then you will pay 20% off the price of the
medication.
8. What are the office hours at the Parque Lefevre office?
R- The hours are from 8:00 a.m. to
12:00 p.m. and 12:30 p.m. to 5:00 p.m.
Monday through Friday.
9- Can I
submit claims and pick up checks at the Parque Lefevre office?
R- Yes, you can submit
claims and withdraw checks at this location.
10- What are
the steps to obtain my medications for diabetes when I travel?
R- In order to obtain
your diabetes medications before traveling, your Primary Care Physician (PCP)
or endocrinologist should complete the Diabetes Disease Management Prescription
Form, detailing the medication prescribed. Attached to this form you must
submit the results of glycosylated
hemoglobin test and your doctor should write a note stating how long you will
be traveling.
11. Can an urologist be my Primary Care Physician?
R-It is not recommended
that a specialist be a Primary Care Physician, but the specialist may request additional
consultation.
12- Can I include
my grandchildren to my Plan and what are the requirements for the inclusion?
R- The
grandchildren are not eligible members of the plan, however if you have the Guardianship and Custody for
the grandchild and the grandchild lives with you, then
that grandchild may be an eligible member in
your plan.
13- How many
PSA exams do I have the right to take in a
year?
R- Under the preventive
care benefit, you are entitled to one (1) PSA test a year. If you have a
pre-existing condition, for example, Prostate cancer or elevated PSA, then
there is no limit.
If you are 65 years or
more, and it is of your best interest to select a participating provider with MEDICARE
because your claims are paid based on the Medicare rate.