all about HMO

[honey_iya]

^Buti pa pala yung HELP card ng fortune care may silbi, bakit naman yung sa amin ni hubby sa fortune care clinic nila sa caloocan nagamit namin pati lab tests, P2,800 lang yun annually

[rumplehuey]

talaga? bat kaya ganun? di ko na malaman kun kanino ako dapat makipag coordinate sa issue na to. Walang sumasagot sa hotline. May pre existing condition pa naman yun father ko.

I was thinking na magagamit ng daddy ko sa mga Fortunacare acredited clinics, uyn pala hinde.  kakainis!

[beautz]

sis hindi mo ba binasa yung nakalagay dun sa website nila? na sa fortune care clinic lang siya pwede magpacheck up unless na lang emergency case like sa gabi. and then yung mga lab works naman kaya di pwede gawin is because of the pre existing clause ng mga healthcard. mine is medserve. i got mine dati mga 2 mos pa lang and then nag paadmit ako because of diarrhea and stomachache. findings sakin is irritable bowel syndrome and gastric ulcer. they did not cover it kasi daw pre existing na daw yun and sabi ko how would you know na pre existing na yun dahil ako na may katawan first time ko lang naranasan yun. then sabi ng friend ko na doctor, kung titingnan mong maige at basahin yung nakalagay sa terms and condition ng contract mo sa healthcard, you will notice that 90 percent of the disease is they put it in pre existing category, and ang alam ko na di pre existing sa kanila ay dengue, typhoid, appendicitis, tonsillitis. at siguro yung iba pa na mabilis lang magdevelop.

[rumplehuey]

It was the agent who told me that my father can use the services available to fortunecare so I didn't bother reading the website. Kaya nga I prepares P12K cash pambayad so he can avail of benefits. Parang feeling ko tuloy I was tricked. I will try to contact them ulit and make clarifications before ko i-continue yung card for next year.

[beautz]

sis the agent will do everything para makabenta siya and thats why sinabi niya sayo na you need to pay it in full para makuha na niya yung commission niya. Ako, I want to pay in full din sana kasi malaki talaga yung difference pag quarterly and semi annual but I want to try the services muna... tapos buti na lang quarterly yung binayaran ko then the services for the INDIVIDUAL ACCOUNT really sucks... pag corporate account yung sayo, mas magaganda yung services..

going back, they will reiterate that the agent should explain to you the clause regarding about pre existing and so on and so forth na exmeptions nila... and then they will tell you na after a year pa saka nila ihohonor yung pre existing illness. it means na on the 2nd year pwede mo na magamit yung labs for pre existing, but,ive read for approval pa to. so like for example diabetes yung sakit, medyo mahirap nila iaapprove to because diabetes, madami complication, pag madami complication, malaki din ang gastos, madaming lab works, di sila kikita baka lugi pa sila sayo. remember na ito ay business, I am from medical field, and ive known doctors na minsan iba na lang yung nilalagay na diagnosis para lang maaccomodate yung patient for laboratory work up. Another more, even on your second and succeeding year, sa fortune care clinic ka lang pwede magpacheck up.

[jolly_meeh]

matagal na pala nag post dito sa thread na to.  I just want to inform you mga sisses na maxicare already covers pre existing on the first year 10k per sickness but tumaas din ang rates nila. 

[honey_iya]

^Sis, paano yung sa lifeline? P100 per month? Saan pwede magpa member?

[honey_iya]

^Yup meron ako sis, ok yun ah. thanks sis

[tazhapaula]

hi mga sis just want to share my experience recently.last tues night i had an accident actually d nman gnun kaserious i had my wrist sprain. di ko sya agad napnsin kala ko naover use [textspeak!] [textspeak!] kamay ko kakabuhat ng mabigat yet i notice a bump on my wrist medyo natakot ako kc nga bka [textspeak!] ko buto un nadislocate o watso ever.so i immediately went to the clinic i use my card (intellicare) and paid nothing yet the doctor advise me to have my wrist cast to a near by hospital in ortigas which was accredited by my hmo. he even gave me a letter of recommendation for the treatment procedure for me.i went their immediately and showed my card pinapunta nila me sa trauma room at the hallway a doctor just ask me [textspeak!] happend and i immediately respond.sabi nya mag antay [textspeak!] ako.the nurse gave me pain killers and an arm sling then assist me the get my xray. after that pinabalik nila kmi sa labas ng trauma room.lumapit [textspeak!] doctor na naginterview sken at first [textspeak!] kng sure ba daw kmi sa sinasabi nmen. i was confuse kc di nman ako pupunta dun kng d din ako [textspeak!] pinapunta nung unang doctor na nagcheck sken.

we waited for several more hrs. hanggng kmi nlng [textspeak!] patient s hallway sa labas ng trauma room.until one nurse approach us and lead us to the billing staff. i was greatful kc i didn't paid anything yet disappointed to see my bill na nasa 2300 lahat samantalang binigyan [textspeak!] ako ng pain killer and xray [textspeak!] nman [textspeak!] ginawa sken. and just advice my to see an orthopedic surgeon of choice.

i was really disappointed that time considering maganda and known hospital yung pinuntahan ko.also i notice iba yung treatment nila sken i mean dahil b i wasnt paying in cash?another question i my mind that time is wala bang iba orthopedic surgeon na pwdng tumingin sken nun since the hospital is already accredited by my hmo.i was calling the customer service of intellicare para tanungin [textspeak!] accredited orthopedic surgeon nila pero wlang sumasagot.that day i tried to go to work yet yung swelling nung wrist at kamay ko andun p din. i decided to go to philippine orthopedic center to have it checked again rather wait for the response from intellicare. atlast my wrist was treated i mean the proper treatment was given to me.

now my wrist is still cast.sna maclearify yung gntong instances ng mga hmo i mean proper treatments sa mga clients nila.even my friend from banco de oro gnun din [textspeak!] [textspeak!] (intellicare din [textspeak!] hmo nila) sa treatment ng doctors s patients n under ng hmo. i mean parang bara bara lang yung service ng hospitals and doctors.

[beautz]

sis i think i parang nagets ko na yung nangyari sayo though I am not sure kung this is related. Im into medical field and somehow im familiar with the hmos. minsan kasi pahirapan magbayad yung hmo sa mga hospital to the point na months yung tinatagal so yung mga hospital sometimes dreaded na nila pag may nareceive sila na patient na who has an hmo card. Another thing barat kasi magbayad yung hmo. example. my gastrologist PF every consultation is 1,000 pesos per patient, and yung mga hmo na nakaacredit sa kanya pays him 400 pesos per consultation. so yun and matagal pa magbayad. sometimes mas gusto nila ang paying compare sa may health card. though sis i am not really sure kung bakit ganun yung treatment sayo. pwedeng hindi good standing yung card mo sa hospital nila.

[tamarind26]

^I agree sis. Yan din sabi ng dentist ko. Maliit kasi ang PF pag HMO then matagal daw magbayad kaya mas preferred nila ang cash. Di ko na rin maintindihan tuloy if advantage or disadvantage na yung pagiging card holder. Parang lumalabas na kasi na iniiwasan na ng mga doctor ang HMO.

[beautz]

if you are working sis and its a company benefit advantage. but if you are individually paying it. dis advantage on your part. Why? mas madami ristrictions pag individual paying ka, pag mag paapprove ka ng labs sobrang daming reason and at some point they will find a loophole dun sayo and will tell you na they will not cover it because its pre existing. Kung titingnan mo yung policy nila regarding pre existing diseases sa mga individually paying members, kala ko konti lang but kung isa isahin mo at himahimayin mo, makikita mo na halos lahat ng sakit covered dun. yung hindi lang talaga nandun is yung biglaan. like tonsilitis na will develop in days lang, dengue also and appendicitis. parang wala na ko maiisip na iba pa. i think even allergic reactions di nila konocover. ah pwede ata yung uti...

[tamarind26]

Comp ben yung sa amin sis. Nasulit ko naman last year for the labs and consultation sa OB. Yung sa dentist lang ang medyo sablay kasi di covered prophylaxis, unlike my Intellicare dati kasama siya. Dun namention ng dentist which HMOs they prefer the most. Pero pansin ko lang din, yung mga indemand doctors seldom na nagpapa-accredit sa HMO (tho di ko naman nilalahat). Are we consumers left with the least known medical practitioners? If di naman maganda yung service na ibibigay why pa sila magpapa-accredit.

[beautz]

sis yung mga in demand na doctors ayaw na nila magpa accredit its because way below yung binabayad sa kanila. yung mga di sikat at di magaling yun yung nagpapaacredit because wala sila patient. so para magkaclient at kumita at makilala yun yung stepping stone nila. minsan nga ang alam ko per hour yung bayad nila sa mga doctor hindi per patient. yung isang doctor namin dito is per hour yung bayad sa kanya parang 800 ata per hour. sa isang oras ilang pasyente na yung macoconsult mo nun.

[tamarind26]

Pagpray nalang talaga na may magagaling and mababait na doctors na magpapa-accredit pa rin with our HMOs. Hope the HMO service will improve kasi the companies naman paid millions for these policies. Di naman lahat ng employees nagkakasakit nang sabay sabay, karamihan pa nga di nakaka-claim in a year.

[chinita8]

For those who might know, my parents who are US citizens have medical insurance under Kaiser Permanente in the States. Can they use it if they will need medical care or hospitalization in the Philippines? If yes, at what hospitals? Thanks.

[beautz]

sis we have kaisser philippines here but I donth think they are affliated with the kaiser permanente in US. Better ask the provider first if they cover international consultation and admission.

[quennna]

so far, kami, wala pang bad experience sa any hospitals/doctors using our healthcards.. entertain naman nila lahat needs namin..
 

[tazhapaula]

thanks mga sis sa reply.now i know kung bkt gnun yung naencounter ko. Ope magbago nga yung services ng mga hospitals and doctors with regards to HMO card holders. Especially those people na individually paying for it.

[bigdadis_girl]

I had the same experience with my healthcard, comp ben din ito but then when I was hospitalized ng biglaan it turned out na parang walang naitulong kame rin ang nagbayad. Tried to settle it sa hr namen and still waiting for the result. Nag file ako ng claim for reimbursements.