Guidelines in issuance of Letter of Authorization (LOA) via EMAIL

  • All consultations should be referred by Accredited Doctors only. 
  • All approvals must come from the main office/Eastwest Healthcare hotline. A diagnostic form without approval code is considered NOT valid.
  • Requests for LOA should be at least a day before the preferred date of availment.
  • The approval of Eastwest will based on member’s plan (e.g. MBL, coverage of pre-existing and dreaded diseases, allowed hospital/clinic access etc.)      
  • Upon issuance of the LOA, the member should bring two (2) copies of the outpatient diagnostic request form (LOA) and the original copy of the doctor’s request to the preferred hospital/clinic. The validity of the LOA is up to three (3) days ONLY.

For queries, you may call (02) 8817-3333 for assistance or direct your email to: inquiry@eastwesthealthcare.com.ph

Advance LOA Request Form
Reimbursement Form (#17)

CLAIMANT’S DECLARATION AND WAIVER

I/We hereby authorize any representative of Eastwest Healthcare, Inc., whenever reasonably necessary, to secure any relevant medical information from the hospital, physician and other reliable sources, including but not limited to documents, records, reports and data, including the medical records, names, addresses, telephone numbers, identification numbers, dates of birth and all other personal information, subject to the rules and requirements of confidentiality under the agreement between Eastwest Healthcare and the Subscriber Company and other relevant laws and regulations in the Philippines, including but not limited to Republic Act No. 10173 or the Data Privacy Act of 2012. A photocopy of this authorization shall be effective and valid as the original.

This holds harmless Eastwest Healthcare, Inc. and the client company for access and disclosure of information related to this claim

REQUIREMENTS FOR REIMBURSEMENT

OPD (OUT-PATIENT)

  1. Original Official Receipts of the Clinic/Hospital
  2. Original Receipts of Physicians Professional Fees
  3. Diagnostic Request/Prescription from Physician
  4. Medical Certificate (in the absence of Physician statement of Reimbursement Form)
  5. Accomplished reimbursement Form

REQUIREMENTS FOR REIMBURSEMENT

IPD (IN-PATIENT)

  1. Original Official Receipts of the Clinic/Hospital
  2. Original Receipts of Physicians Professional Fees
  3. Statement of Account
  4. Medical Certificate (in the absence of Physician statement of Reimbursement Form)
  5. Accomplished reimbursement Form

REQUIREMENTS FOR REIMBURSEMENT

HIB (Hospital Income Benefit)

  1. Original Medical Certificate/Discharged Summary
  2. Original Official Receipt
  3. Original Statement of Account (Detailed and Summary)

REQUIREMENTS FOR REIMBURSEMENT

SURGICAL CASE

  1. Original Official Receipts of the Clinic/Hospital
  2. Original Receipts of Physicians Professional Fees
  3. Diagnostic Request/Prescription from Physician
  4. Medical Certificate (in the absence of Physician statement of Reimbursement Form)
  5. Operative Technique/li>
  6. Statement of Account
  7. Accomplished reimbursement Form

REQUIREMENTS FOR REIMBURSEMENT

EMERGENCY CASE

  1. Original Official Receipts of the Hospital
  2. Original Receipts of Physicians Professional Fees
  3. Statement of Account
  4. Medical Certificate (in the absence of Physician statement of Reimbursement Form)
  5. Accomplished reimbursement Form

REQUIREMENTS FOR REIMBURSEMENT

SARS-CoV-2 PCR test (RT-PCR and Cartridge-based PCR)

  1. Accomplished reimbursement form
  2. Copy of Result
  3. Doctors request or referral
  4. Original Receipt

Member Feedback Form

Member feedback form

DETAILS:

For Eastwest to verify and act accordingly, please cite names, time, place and other pertinent details.