Alliances
All insured patients must bring their physician’s order, duly completed by the attending physician, with the following data:
- Signature, physician’s stamp with license number and diagnosis.
- Please verify the procedure and requirements with your insurance company.
“Mediprocesos RPN” Procedure
The insured patient shall bring:
- The laboratory or radiology order, issued by the affiliated physician
- Insurance card
- In case of special procedures, the corresponding authorization
Special procedures that require authorization:
- Tomographies
- MRI Scans
- Ultrasounds
- Bone Densitometry
- Doppler
- Colonoscopy
- Holter Monitor
- Electroencephalogram (EEG)
- Evoked potentials
- Somatosensory evoked potentials
- Auditory evoked potentials
- Visual evoked potentials
- Electromyography (EMG)
- Scintigraphy
“Seguros G&T” Insurance Company / Medired Procedure
The insured patient shall bring:
- Insurance card
- Authorization
- Original authorization form filled out by the attending physician
“Seguros El Roble” Insurance Company Procedure:
The insured patient shall bring:
- Insurance card
- Authorization
- Identity card
“AIG La Aseguradora de Centro América” Insurance Company Procedure:
The insured patient shall bring:
- Physician’s order (original)
- Health insurance identity card
“Aseguradora Mundial” Insurance Company Procedure
The insured patient shall bring:
- Insurance card
- Identity card
- Fax letter of authorization for special procedures
- Responsibility letter duly completed in sections 1 and 2 for tests without authorization
- Physician’s order issued by the treating physician
“Aseguradora General” Insurance Company Procedure
The insured patient shall bring:
- Pre-authorization form
- Outpatient form (blue copy) completed and valid insurance card.
- Inpatients: the hospital will send the authorization. It may be through an order or a fax letter, indicating the value of the co-payment.
“Seguros de Occidente” Insurance Company Procedure
The insured patient shall bring:
- Insurance card
- Authorization
- Authorization application for special procedures
“Seguros Agromercantil” Insurance Company Procedure
The insured patient shall bring:
- Insurance card
- Request Form for special procedures and laboratory tests in original, duly signed by the insured patient, and duly signed and stamped by the treating physician, “Seguros Agromercantil” Insurance Company and the contracting company (employer).
“Seguros Universales” Insurance Company Procedure
The insured patient shall bring:
- Insurance card
- “Unired” laboratory or radiology form signed and stamped by the treating physician and the insured patient.
- Authorization
“Seguros Panamericana” Insurance Company Procedure
The insured patient shall bring:
- Insurance card
- Identity card
- Laboratory and X-ray claim form completed as follows: Section A1: completed by the insured. Section A2: completed by the employer, except for individual policies. Section A3 as well as Section B: completed by the treating physician. The last section is completed by the Diagnostic Center.
- All imaging tests require authorization
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