Services
PPO Network
We maintain a network of doctors and hospitals throughout Brazil, considered one of the best in the country. We guarantee discounts on bills that vary between 10 and 35% for inpatient services, outpatient services, therapies, cancer treatments (except medications), complementary exams, home care, geriatric and psychiatric clinics, through contracts with pre-agreed discounts.
In addition to the contracted network, we operate worldwide through partnerships with referenced platforms and providers (doctors, hospitals and clinics).
Our PPO network is available to all customers who want to hire it and its expansion is carried out according to the needs of our customers, focusing on locations where there is a volume of service.
Due to agreements with PPOs in other countries, WA offers discounts, between 10% and 40%, in a network with more than 10,000 hospitals and medical facilities, covering the United States, Canada and Mexico, Central America and Europe.
International Assistance
To ensure that our passengers with domestic and international Insurance Assistance from our client companies may use and benefit from the wide network of medical, dental and legal assistance, serving them in the most varied services, according to coverage.
Cost Containment
Cost Containment starts as soon as services begin. We have developed our own team of specialists, diversifying methods to maximize savings, while ensuring that the best assistance is provided.
We have also developed a network of preferred providers and a discount negotiation system, providing your customers with the best cost-benefit ratio.
Call Center
Responsible for requests for medical, dental, legal, hospital assistance, Customer Service, quality control, request for Guarantee of Payment, Verification of Benefits and eligibility, authorization, validation or any matter pertinent to the services contracted by the customer.
Case Management
Case Management is a significant part of cost containment and control. Through this, we are able to obtain from medical assistants / hospitals the guarantee that patients are getting adequate treatment at a fair price.
Our Case Management is performed by nurses, and supported by a medical team and social workers. These professionals work together with our team, under the supervision of a Medical Director, to offer the best support in terms of clinical and financial results for each case.
Análise de Riscos
WA acts as the client's intermediary with providers participating in the Preferred Provider Organization (PPO) to evaluate the care provided, always respecting the confidentiality of the clinical condition and without damaging the image and reputation of its clients.
The Risk Analysis comprises the following levels:
Chronic Management
Program developed to support patients in need of assistance in chronic diseases.
It is administered by graduated nurses with clinical experience, supervised by a Medical Team that will coordinate the needs of each case and the patient's participation in the program.
The aim is to provide well-being to participants and provide important information about their medical staff, such as education and self-monitoring, in addition to providing access to appropriate medical resources. Support is offered for the following pathologies: diabetes, asthma, hypertension, mental or psychiatric disorders and cancer.
Hospice (Palliative Care)
Focused on palliative care for terminally ill patients. The symptoms can be of physical, emotional or social nature. What we propose is to make patients feel better about themselves, treating symptoms and improving quality of life, instead of trying to get a cure.
Second Medical Opinion
The goal is to certify the clinical need for surgery and confirm that the patient is fit for the procedure. It is performed by a second doctor or specialist when a specific diagnosis is obtained or surgery is recommended. There are economic factors involved in the second medical opinion. This is a system, which, if well regulated, has a good potential to reduce treatment costs, as well as the incidence of risks and errors.
Medical Regulation
It consists of cost-benefit analysis, aiming to achieve effectiveness in meeting the needs of customers.
When called upon to organize a service, our specially trained team will carry out a preliminary analysis of the case. If we identify that the service has characteristics of high cost, long stay, use of Special Supplies or inconsistency in the request, our team will refer the case for medical regulation.
Our medical team will study the case analyzing the list of materials ordered, when applicable, in addition to comparing items such as diagnosis x procedure; procedure x Special Supplies; and procedure x estimated hospital stay.
Through the evaluation it is possible to avoid exorbitant and unnecessary high cost procedures.
UCRUsual, Customary, Reasonable
We have a team specialized in reviewing medical fees (in Brazil and in the contracted countries) that will assess the presented budget, considering mainly the following aspects:
- Procedure complexity level;
- Level of professionals involved;
- Location where the procedure will be performed.
Upon evaluating the three requirements, our team is able to calculate a reference value and compare it with the budget presented to determine if the value is within reason.
If the amounts are above the reasonable, our team will contact the professional in order to negotiate the presented fees, before carrying out the procedure.
We can also provide this assessment after the procedures, in cases of reimbursement, to ensure that the reimbursed amount is fair.
Direct Billing
Direct Billing consists of organizing insurance payment to doctors and / or providers that do not participate in the PPO network. Even if the provider is not contracted, or refuses to arrange an agreement for a specific case, it would be possible to charge the insurance company directly.
Claims Analysis
WA has a qualified Claims Analysis Department, suitable for the different needs of customers, checking all items charged on medical and hospital bills, submitting them to benefit and coverage coordination when applicable.
Our team is trained to recognize worldwide billing practices and possible fraud and irregularities.
Medical Audits
Our team is composed of specialists responsible for auditing the bills, establishing the correct relationship between the cost and the charged service, controlling the quality of the services provided in the hospitals / health facilities chosen by the client. They also perform specialized technical services for external auditing aimed at hospital events / claims that comprise various hospitalization regimes, designated by the company / client.
The audit comprises the following services:
Clinical Medical Audit
External medical audit of claims / events exclusively of clinical specialties, which do not pass through specialized units.
Surgical Medical Auditing
External medical audit of claims / events exclusively for surgical specialties, which do not pass through specialized units.
Specialized Medical Audit
External medical audit of claims / events exclusively in specialized units, such as Coronary, ICU, ITU, among others.
Hospital Bill
Document comprising the services performed by the service provider, which may also include services provided by another individual and / or legal entity that complement the assistance.
Medical Visit
Monitoring of hospitalized patients, through access to medical records. WA has a network of medical and nursing support to supply its clients in case of need for representation on site.
Conducting constant internal training to detect potential fraud has made WA one of the best companies in offering audit services.
Directional Program
Online system used to assist operators in locating providers in our PPO Network.
To ensure that new providers are easily found during the search, WA constantly updates its database.
Pharmacy Network
WA has joined the main Brazilian pharmacy chains: Raia Drogasil and Grupo DPSP. Policyholders can take advantage of discounts at more than 2,000 stores distributed in Brazil.
