How to claim a refund

If treatment is performed by affiliated direct-provision healthcare facilities, refunds will be claimed directly by the facilities themselves; in this case, please note that the original expenditure documentation must be given directly to clients by these healthcare facilities.

Please note that members will be solely responsible for correctly retaining their original accounting documents and will be personally liable for these in the event of inspection by the tax authorities.

Fasi reserves the right, when it deems necessary and for any checks it has a duty to make, to ask members to produce the original documentation that it has already been sent as a photocopy for refund purposes. Failure to produce the required originals will prevent refunds from being paid.

Refundable services and their provision are defined and regulated by:

• article 4 of the Statute and Article M of the Regulations;
• the executive norms established by the Fund’s Governing Bodies and set out in the Warnings and the Introduction to the Fee Schedule, the services claim form and the Treatment Plan;
• specific communications and circulars available in the forms for managers section.

We remind you:

• if sending refund claims in printed format, to keep your proof of posting (registered or insured mail receipt) as a guarantee against possible problems in the post;
• that you can submit refund claims and the relevant expenditure documentation at any time by logging onto your Private Area on the Fasi website, using your membership number and password, by the deadlines set out in Article M of the Regulations;
• to submit claims to the Fund by the last day of the quarter following that in which the relevant expenditure documents were issued, and to attach all accompanying documentation where requested..
• to not include expenditure documents relating to non-refundable services, since these cause delays in processing the file.

Please note that the provision of services is dependent on the regular and continuous payment of premiums.

EXCEPTIONS TO QUARTERLY SUBMISSION

Refund claims can be sent immediately after the service has been provided, provided that this is done within the deadlines set out in Article M of the Regulations.

Expenditure documents sent after the deadlines will be rejected regardless of the number of days overdue.

As specified in the Warnings pages of the Nomenclature-Fee Schedule, only the following exceptions exist:

• Refund claims for dental treatment
• Invoices on account

In these two cases, you must read the Warnings pages of the Nomenclature-Fee Schedule for information on how to send documents to the Fund correctly.

ACCOMPANYING DOCUMENTS

As regards dental services, please refer to the specific approach to take outlined in the current Nomenclature-Fee Schedule.

For all other services, where the nature and quantity of the services carried out are not clear from the expenditure documentation, you will need to submit the relevant details to the Fund.

Before sending any refund request, you must therefore check that the above information exists, since failing this Fasi will suspend its processing of the file with resulting inevitable delays in payment of the refund due.

We remind you that:

• In the event of HOSPITALISATION, with or without surgery, a copy of the medical records must always be attached.
• In the case of PHYSICAL THERAPIES, details of the therapies performed (types of therapy and number of services) and the medical prescription for these must be submitted; additionally, the professional qualification in kinesitherapy of the person who provided the service must be clearly indicated, and in the case of therapies performed at specialist centres the specialisation of the centre itself must be clearly indicated.
• In the case of DIAGNOSTIC TESTS, you must send details of the services provided as well as the prescription of the treating physician indicating the type of pathology that made the tests themselves essential.
• In the case of SPA TREATMENTS, a specific medical prescription must be sent certifying the need for the treatment itself and specifying the pathology currently existing.
• In the case of a SPECIALIST CONSULTATION, the documentation submitted must clearly show the title of specialisation of the physician who gave the consultation, which must be relevant to the pathology detected.

NON-REFUNDABLE SERVICES

There are some services for which Fasi does not provide refunds.

We therefore recommend that you do not submit claims for services not covered by Fasi since they cause delays in paying claims, encumber the work of normal processing and may lead to misunderstandings and unintentional errors. You can find information about non-refundable services in the “Exclusions” section of the Nomenclature-Fee Schedule.

REGULAR PAYMENT OF PREMIUMS

Services are paid for provided that there is continuity and regularity in the payment of premiums (Article M of the Regulations).

Checks on the correct payment of premiums are automatically carried out upon the arrival and registration of the refund claim: if any irregularity in payment is detected, a notification is automatically sent by post or email (protocol letter 2707); if the membership is not regularised within six months of submission of the refund claim, the claim is definitively rejected. In the event of regularisation within the deadline specified in the Statute, consideration of the refund claim is automatically resumed.

LIMITED SERVICES

Summarised below are the main limits to certain services for each client:

• daily hospitalisation fee, maximum 90 days per calendar year (calendar year means 365 days from the first day of hospitalisation);
• mud and balneotherapy, maximum 12 days in the relevant year of the service;
• hydropinic and inhalation therapies, maximum 10 days in the relevant year of the service and for a maximum of 3 years;
• physiokinesis therapy services, for a total of 80 services a year (1 January – 31 December) regardless of the type, technique, instrumentation, or any anatomical district treated; excluded from this limitation are acupuncture services and equipment rental, which have their own annual limits. We draw your attention to possible exemptions from this limit as set out in the Warnings section of the Nomenclature-Fee Schedule;
• acupuncture, 10 sessions per year (1° January – 31 December);
• rental of in-home physiokinesis therapy equipment, maximum 60 days per year (1 January – 31 December);
• treatment for prostate disease using prostathermer, 1 annual treatment cycle;
• shock waves, both rates, for a maximum of 6 sessions per year;
• intravitreal injection for wet macular degeneration for a maximum of 5 treatments per year.

For dental services, please see the specific rules set out in the current Dentistry Nomenclature-Fee Schedule.

INDIRECT CARE THROUGH LOCAL HEALTH AUTHORITY

Although the rules vary by region, refunds are available from regional health authorities for healthcare services carried out in private facilities (hospitalisation, surgery and, in some cases, diagnostic and dental services).

We remind you that, for any remainder payable by its clients, Fasi provides any refunds according to the usual rules and fee schedule.

To initiate the paperwork for indirect care we recommend that you contact your local health authority before receiving healthcare services for information on the necessary procedure.

THE SERVICES CLAIM FORM

Refunds for dental services must be claimed by following the specific procedure set out in the Nomenclature-Fee Schedule for Dentistry.

We remind you, however, that a specific function – Print form with label – has been provided in your Private Area enabling you to print the form with its own bar code; you can also complete the form online, enabling you to check your personal data and premium payment status in real time.