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AUTORIZACIÓN PARA PEDIR COMUNICACIÓN CONFIDENCIAL DE INFORMACIÓN MÉDICA

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Estas son las comunicaciones que esta petición cubrirá con confidencialidad:

  • Factura
  • Aviso de determinación adversa de beneficios
  • Explicación de beneficios
  • Información sobre reclamos
  • Aviso de reclamos impugnados
Método preferido de comunicación:
Duración: esta autorización es válida hasta que el suscriptor o afiliado presente una renovación de la petición o presente una nueva petición de comunicación confidencial, sin requisito de renovación anual.