Claims Procedures
The following notes deal with some specific aspects and commonly asked questions relating to your cover.
They are not exhaustive and you should contact us for advice on any aspect of your policy that you do not understand.
How you obtain the benefits your plan provides
What to do before receiving in-patient and daycare treatment
Pre-authorization
The reason that we require pre-authorization of planned treatment is to protect you from unexpected costs. When issuing confirmation of cover in this way we confirm the following:
- The planned treatment is eligible under your policy;
- The planned treatment is medically necessary;
- The planned treatment is within reasonable and customary costs;
- The planned treatment cost falls within the remaining benefit limit of your plan.
Our agreement with your company requires you to seek pre-authorization for the following treatment and services:
In-patient and daycare
- All in-patient and daycare admissions
- All non-emergency tests, diagnostics, treatment, surgery and other medical services
- All in-patient maternity services
- All in-patient dental services;
Out-patient
- All in-patient and daycare admissions
- All non-emergency tests, diagnostics, treatment, surgery and other medical services
- All in-patient maternity services
- All in-patient dental services
- On-emergency MRI, CT, PET and Gait scans such as but not limited to endoscopy, colonoscopy, gastroscopy etc.
Physiotherapy services
Prescriptions covering consumables for 30 days or more;
All out-patient dental services received on direct billing basis; Failure to obtain pre-authorization, as required above, may prevent us from settling all or part of any claim. In the event that we are obliged to pay for any item not covered by our confirmation we will recover that amount from you. In any event any cost that is not directly related to treatment will be borne by the member.
Treatment outside network
If you are planning treatment outside the direct settlement network shown for your plan you must arrange pre-authorization at least five days prior to commencement of the treatment for which authorization is required. You must confirm with the hospital that it has received our written authorization before you undergo treatment. If it has not, you must contact us immediately.
We must be advised of any proposed treatment before treatment begins. Failure to allow us to manage your care, wherever it is received, may expose you to additional costs.
Emergency treatment
The only exception to this will be if the treatment requires an emergency admission, then you may not be able to contact us beforehand. Do, however, ask somebody to contact us as soon as possible and make sure that, when you are admitted to hospital, the hospital is given your membership card and proof of identity so that it can contact us straight away. In any event, under these circumstances, our authorization must be sought and given before you are discharged otherwise you may be required to pay the entire cost of your admission.
Claim forms
You can visit our website at www.alkoot.com.qa to obtain a printable claim form if you need one. You must provide a completed claim form, signed by the medical practitioner and the member, for any visit made whether this is to a practitioner, hospital, clinic, pharmacy, diagnostic centre or any other facility where medical services may be received.
Claim forms inside our direct-billing network
When you register at a direct-billing network hospital and identify yourself as a member you should be given a claim form. If not, please ask for one. It is your responsibility to ensure that this is fully completed and signed by you and the attending medical practitioner. The direct-billing network hospital will send the completed claim form to us.
Claim forms outside our direct-billing network
If you are not being treated in a hospital listed in the direct-billing network list covered by your plan a different process applies. You must take a claim form with you and make sure it is filled in and signed by yourself and the medical practitioner treating you and sent back to us as quickly as possible, giving us all the information we request. (Only original receipted invoices can be accepted with your claim). A fully completed claim form will ensure your claim will be processed promptly. An incomplete or unsigned claim form may delay settlement of your claim and in some cases may lead to the claim form being returned to you for completion. It may be necessary for us to obtain a medical report from the attending medical practitioner. If the medical practitioner does not respond quickly to such a request your claim may be delayed. We do not pay for medical reports. For treatment requiring our pre-authorization, such authorization must be received from us, in writing, prior to treatment commencing. A copy of that authorization must be included in your subsequent claim. Please note that, for reimbursement claims, we will only consider claims made within 90 days of treatment being received.
Where to send your claims
Any bills, together with your completed claim form, should be sent to:
Al Koot Global Care Plan, Al Koot Office, Al Maha Building, Bin Omran Area, PO BOX 24563, Doha, Qatar
For all telephone inquiries AXA Phone in Qatar Tel: +974 412 8733, +974 800 5668
Schedule of Procedures
In the agreement with your company and this guide we refer to a schedule of procedures which is a document that lists the proven surgical procedures for which we pay benefit and classifies them by complexity. Each of the procedures is also given a code number for administrative purposes. There are in excess of 1,000 procedures listed, of which about 250 are commonly performed on a daily basis. This document is written in medical language and it is intended for use by medical practitioners and us to assess the eligibility of proposed treatment and your claim. The schedule is regularly updated to include new, proven, procedures and is retained by us.
Treatment abroad
If you need treatment abroad you will need to call AXA Insurance on
+ 974 412 8733, +974 800 5668. If your medical practitioner recommends hospitalization or a major out-patient procedure then call the above telephone number to confirm that you are entitled to benefit. Any bills, together with your completed claim form, should be sent to Al Koot Global Care, Al Koot Office, Al Maha Building, Bin Omran Area, PO BOX 24563, Doha, Qatar.
Payment in local currency
Regardless of your area of residence your premiums are payable in Qatari Riyals. Claim reimbursement will be paid in the same currency unless we have previously agreed otherwise in writing.
Benefits paid in a local currency will be converted using the closing mid-point exchange rate published in the Financial Times Guide to World Currencies current when we assess the claim.
Any questions?
Although we have tried to include as much useful information in this handbook as possible if you have any questions about your cover then please direct these, in the first instance, to your HR Department. Alternatively you may contact Al Koot Insurance. Details of how to contact us are shown on the Introductory page.
