MAPFRE LIFE’s pre-authorization program is designed to help you receive quality health care in a cost effective manner. The need for quality health care at a hospital, outpatient surgery, and special studies are evaluated.
When your doctor determines that you need to be hospitalized or outpatient surgery or a study process, highly specialized trained medical personnel from MAPFRE LIFE will validate the treatment plan and medical needs and then make recommendations based on four important factors using criteria established by medical evidence and known in the medical field.
- Medical needs - the proposed treatment is right for you or your dependent according to their diagnoses.
- Location of treatment - that the treatment place is right and that you and our doctors are given the opportunity of cost-effective treatment with the best quality and service.
- Length of stay accurate - that the hospital stay is neither longer nor shorter than what is required for your medical condition. You and your dependents must be hospitalized for the necessary time required by your condition according to the latest medical guidelines.
- Appropriate treatment proposed by the doctor who requests the admission - your doctor must provide medical or surgical treatment to you according to the diagnostics.
Do all persons insured by MAPFRE LIFE require prior certification?
No. Not everyone insured by MAPFRE LIFE undergoes pre-certification reviews. You must identify your participation in the pre-authorization program according to your policy coverage. Services will be pre-certified according to the negotiated and group plan coverage. The process begins by placing a phone call to the customer service department.
Why do I have to be pre-authorized?
If your doctor tells you or your need depend on an admission or outpatient surgery or a study process, which is not covered, you must follow these instructions:
- Contact the following telephones: 787-250-5214, 1-800-981-3271 (Puerto Rico).