Self Insurance Policy

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The Objectives of the Program :
Program aims to develop the performance of medical departments for institutions through the use of computers in all data entry and financial processes (Referral notes and Claims) by the medical care department which provides the following advantages :

Benifits

  1. List of benefits
    Providing a complete medical procedural manual being the main guide for the doctor in the treatment process .
  2. Full control of inpatient hospital bills by reviewing the computer on the medical and financial level to appropriate consumables and the prescribed items of the invoice to the type of surgical operation performed and filtering questionable invoices on a particular screen, which saves time and effort for medical and financial auditors professionals by ensuring the credibility and accuracy of bills to the highest level .
  3. Full control in the prices of services provided and ensuring that they conform to the price lists contracted with medical service providers (hospitals, pharmacies, radiology centers and analysis, etc ...) and make sure that there are no over payments made in accordance with the contract .
  4. Control that no extra services are received over the pathological condition needed for the worker through the service provider in emergencies, as well as make sure that no increase in the quantity of service provided made by the doctor .
  5. Full control of the overall cost of medical services .
  6. Ability to issue analytical reports to evaluate the doctors performance and service providers .
  7. Ability to issue payment orders and checks very accurately in a short time .
  8. Ability to apply medical strategies for all diagnoses and issuing reports to evaluate the therapeutic efficiency of this strategy periodically .
  9. The ability to upgrade and modify this strategy easily and smoothly .
The ability to update and learn automation of the therapeutic strategy in real life and the actual bills after the approval of medical supervisors for the addition or modernization of the access to the latest tools and treatment services available .

    I: The Obligations of Service Director “Allied-Doctors” Management for Medical Services

  1. The Service Director is committed to providing an integrated network of medical service providers (hospitals, pharmacies and clinics, and radiology centers ...) it is responsible for providing medical and therapeutic services to participants at the highest level of efficiency. Allied-Doctors medical management system overlooks the providers’ performance on an “on-line” basis using modern techniques and with the consent of the client, who is entitled to object to the level of any unit of the network .
  2. After signing the “contract” the Service Director will deliver a membership card to each participant for identification of the participant indicated by the definition of subscriber name and the type of coverage allowed and the validity of the card and addresses and emergency telephones for hospital admissions or services request.

    As the service director "Allied Doctors" also manages and organizes the following medical services :

    1. The follow-up of cases that are treated within hospitals through constant visits from “Allied-Doctors” doctors to ensure the safety existence of a medical service performed for the insured patients .
    2. The issuance of prior approvals necessary for the conditions of hospital admissions in non-emergency cases as well as in cases of treatment that require the prior approval of the company, such as certain types of radiation or chemotherapy treatment, or the treatment at a non-contracted party with the company ... And according to what is provided for in the contract model .
    3. Provide all the statistical and analytical reports (financial and medical) periodically or when requested by the appropriate official of the company .
    4. Issuance of all financial reports for direct payment to the service providers for the costs of medical services performed including hospitals, pharmacies, factor analysis, radiology centers, physiotherapy centers, as well as the fees for medical examinations at private doctors’ clinics .where Service Recipient will pay to the Service Director by a check for total claims.
    5. Periodic follow-up and continuous level of services that lead and make sure not to breach the system of work by the providers of medical services. Ensure that employees will get the agreed benefits at ease within a disciplined framework that makes sure the benefit goes to whom it deserve without troubles, this can be done through the statistical data that are provided periodically by the developed medical and finance program
    6. All discounts granted to “Allied Doctors” from medical service providers are considered an acquired right to Service Recipient.
      “Allied Doctors” Company together with Service Recipient’s officials is to formulate the internal procedure for curing employees and the regulations for receiving medical services for them.

II: The Obligations of Service Recipient are :

  1. Providing preliminary data necessary for the operation including classes of employees and coverage allowed to each of them .
  2. Monthly updates of new additions and deletions to update databases and registries .
  3. Payment of claims that have been reviewed technically and financially by Service Director not later than fifteen days of receipt of invoices and reports by a total check as  "Allied Doctors".
  4. Full responsibility of expenses payment for the treatment of employees in case of cancellation of contract or expiration of the duration, not less than three months subsequent to the date of cancellation or expiry of contract.
  5. Full responsibility for bills payment of the employees which have been deleted due to their resignation without pulling their private medical cards.

III: Practical experiences for applying the “Allied Doctors” Medical Protocols
Through practical experience using the program in several institutions such  as (EZZ Group, Sheraton Hotels, Ernst & Young, Nations Conference on  Trade and Investment (NIKE), the Egyptian Company for the transfer of data  (TEDATA), NSGB, .....) the possible outcome was as follows :

  1. Expenses have been reduced for inpatient hospitalization by a rate ranging from 25% to 35% of normal expenditure disbursed before using the program .
  2. Expenses have been reduced for external treatment (medication, tests, radiology centers and outpatient clinics, etc…) by a rate ranging from 10% to 25% of normal expenditure disbursed before .
  3. Provide all the analytical reports of the performance of service providers and institution physicians and all parties involved in the therapeutic process, which has helped to improve performance and effectively change the therapeutic strategy to reach optimum development .
  4. Ability to issue payment orders and checks for service providers very carefully and in a short time, has contributed to an immediate improvement in the relationship between institutions and between service providers, which is reflected also to improve the level of service received by the employees with different service providers .

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