Insurance Policy & Coverage Information

1. Is insurance applicable for treatment at Akari Wellness & Treatment Hub?

Insurance coverage may be applicable depending on the client’s insurance provider, individual policy benefits, exclusions, territorial coverage, and eligibility requirements.

Coverage is not automatic and not guaranteed. All insurance approvals, reimbursements, benefit limits, and timelines are determined solely by the insurance provider. Akari Wellness & Treatment Hub does not determine insurance eligibility, coverage, or approval outcomes.

2. Does Akari Wellness & Treatment Hub provide direct insurance or HMO billing?

No. Akari Wellness & Treatment Hub does not provide direct billing to local HMOs, Philippine private insurance providers, or international insurance companies.

All insurance-related transactions are handled on a reimbursement basis, subject to the policies, procedures, and approval processes of the insurance provider.

3. Assessment Protocol & Recognized Philippine Tools

(Important for Insurance Claims and Clinical Documentation)

Akari Wellness & Treatment Hub follows Philippine Department of Health (DOH) regulations and clinical standards. Insurance providers are advised to review claims based on these DOH-recognized clinical assessments:

• Drug Dependency Examination (DDE)

This is the formal "gold standard" assessment mandated under Philippine law. It must be conducted by a DOH-accredited physician. The DDE is a comprehensive medical and psychiatric evaluation that determines the required level of care:

• ASSIST (Filipino Version)

Akari utilizes the local adaptation of the WHO’s Alcohol, Smoking, and Substance Involvement Screening Test. This is the primary screening tool used in Philippine community-based settings to determine initial risk levels for Persons Who Use Drugs (PWUD).

• DAST-20 (Tagalog Version)

Where applicable, the Drug Abuse Screening Test (validated in Tagalog) is used to evaluate the clinical severity of drug-related problems.

• Foreign Assessment Tools

Please note that MATE and other foreign instruments are not part of the official assessment protocol in the Philippines. As a DOH-accredited facility, Akari cannot substitute the DDE with foreign tools for official clinical documentation or compliance purposes.

4. Insurance Options for Residents and Overseas Clients

1. Philippine (Local) Residents

Residents may hold local HMOs or private medical insurance.

Key considerations include:

• Most Philippine HMOs do not provide direct coverage for outpatient behavioral health, addiction treatment, or Intensive Outpatient Programs (IOPs).
• Coverage is typically limited and reimbursement-based.
• Approval depends on specific policy exclusions and DOH-standard diagnostic classifications.

2. Overseas or Foreign Clients

Coverage for international or travel insurance is subject to:

• Territorial applicability (coverage within the Philippines).
• Pre-authorization requirements.
• Policy exclusions for substance use or mental health.
• Confirmation that treatment in a DOH-accredited Philippine facility is eligible for reimbursement.

5. What Is Akari’s Role in the Insurance Process?

Akari’s role is strictly limited to documentation support.

Akari provides:

• Medical certificates or physician’s diagnoses (DOH-compliant / DDE-based).
• Treatment plans and IOP program descriptions.
• Official receipts and statements of fees.
• Discharge summaries and progress documentation.

Akari does NOT:

• Act as an insurance intermediary.
• Communicate directly with insurance providers regarding claim approvals or denials.
• Guarantee reimbursement or coverage.

6. How Does the Insurance Claim Process Work?

1. Inquiry: The client confirms coverage and requirements with their provider.
2. Treatment: The client completes the admission and treatment program at Akari.
3. Documentation: Akari prepares the necessary DOH-compliant clinical documentation (including DDE results).
4. Submission: The client or representative submits the claim directly to the insurance provider for reimbursement.