all about HMO

[sapphire201]

Bakit ganun [textspeak!] mga doctors na accredited ng medicard more or less they are very incompetent. Just want to share a scenario and should be aware of.   I had my cyst (as per checking sabi sebaceous cyst daw) checked by one of the OB who is accredited by medicard (Makati Med) Dra. Ma. Liza Francisco, bigla nalang nya ako hiniwa (incise) near my genital area without my full consent.  No anesthesia then 3x niya akong hiniwa, the first time na hiniwa niya she said ay wala.. the second time hindi parin tumama then the 3rd time. She really seemed to know what she is doing.   Ang bilis ng lahat ng pangyayari, ang bilis bilis niyang kumilos grabe parang alam na alam [textspeak!] ginagwa niya..

After 3 days, when I touched my cyst and the incised area, I found out maling area [textspeak!] hiniwa niya and the cyst of course is still there. 

Please help, shall I get back to her for the follow up check up or just let the wound heal?!  Hay, ang sakit ng hiwa and the worst thing is, mali [textspeak!] part na hiniwa niya.

[$ale... seeker!]

^ OMG! file a complaint, rest for now then look for a credible physician...

[goddessjem]

sis sapphire, tama si sale seeker..file a complaint. hindi mo pwedeng ipag walang bahala yang ginawa sayo. medicard member din ako. hindi ako gaanong kuntento sa kanila. lalo na clinic based lang yung package ng office namen. pwede lang kame sa hospital, kung tipong accident/emergency lang. wala sana problem sa akin kung clinic based. kaya lang, kapag magpapacheck up/consult ako, wala naman yung doctors/psecialist na kailangan. parang kailangan magpabalik balik pa..

[a_y_e_n]

^^^naku parang medical malpractice ata yan? wala pa naman ganyan sa pilipinas.

para di OT, yung HMO namin, covered ng company namin. sa intellicare kame. ok naman kahit papano madami naco-cover. pero mas gusto ko sana yung maxicare, yun kase HMO namin sa company before eh.

[sapphire201]

hi sale seeker and  goddessjem! i tried to complain sa mismong MMC medicard office pero wala naman nangyari.. sabi gawa raw ako ng written report to medicard head office, naisip ko naman wala rin naman action na mangyayari kaya hindi nalang ako tumawag pa..

pero sige if i find time try ko tumawag sa medicard office

[goddessjem]

hay naku..ka bad trip yang card ko..may procedure na gagawin sa akin. the problem is, ang liit ng lang ng limit ko para dun sa category ng disease ko. ang complaint ko..nag charge sila dun sa category ng diseade na hindi naman dapat naka charge dun..hahaha..magulo ba? sensya kung hindi ko ma explain ng maayos. ilang araw na ako tumatawag sa medicard.napakahirap pa naman tumawag dun. kung may makausap man ako, papatwagin ako ulit kase hindi masagot yung concerns ko..

[-charm-]

hi sisses, may nakakaalam ba sa inyo kung covered ng maxicare yung eye lasik treatment? gusto ko sana ipa-lasik yung dad ko kaya lang masyado mahal. thanks!

[laimelai]

naku mga sis, advice ko lang, NEVER get CARITAS!
grabe! nastroke nanay ko hah, hindi parin nila sinagot! ang dami narin nagrereklamo sa kanila, and most of them are retired employees already. imagine the heart ache they have caused these elderly folks! tamang tama ang name nila para sa kanila.

Caritas Health Shield (they shield themselves from your health)

super nag attempt na kami and all, nagsubmit ng evidences and papers, still, they give us LAME and LOUSY excuses to NOT give my mother the benefits she deserved from them!
 

GRABE! SAKSAK NILA SA BAGA NILA MGA PERA NG CLIENTS NA NILOKO NILA! MAKARMA NA SANA SILA!

[ikaela]

^Madami ako nababasa na good and bad reviews on Maxicare, Medicard and etc. but Caritas always has the most rage-filled bad reviews. Yung sa ibang HMOs parang mga irks lang, pero pag Caritas, talagang "WAG KAYO KUMUHA NG CARITAS"!

Gusto ko pa naman yung money back guarantee nila pero parang di na worth it dahil sa dami ng bad reviews. Mabuti na magbayad ng masmahal basta mapunan naman yung pangangailangan mo pag kailangan na kailangan na talaga. Hindi yung paiiikutin ka pa!

[hardyrissa]

so far maganda naman reviews naddinig ko sa caritas.

[chelsee]

so yearly ba magbabayad ng fees nila? ano mas okay maxicare or medicard?

[AlexTin]

Hi mga sis, agent ang hubby ko ng iba't-ibang HMO, kaya familiar na ako sa mga issues ng mga HMO. Ang mga ok na HMO ay MEDICard, Maxicare at Intellicare. Actually ang majority na problema sa ganyan ay ang mga package na pinili ng company, minsan hindi covered yung sakit nyo o kaya mababa ang limit. Kung nahihirapan naman kayo makatawag sa mga call center ng HMO, pwede nyo ipadaan sa agent nyo, yun ay kung visible sila. Ang husband ko naman sobrang visible sa mga client kasi nilalagay nya ang contact number nya at kung nahihirapan ang mga client na makipag-usap sa call center or sa mga approving officers sya mismo ang pumupunta sa office para kausapin sila.
Kung interesado pala kayo, pwede nyo refer ang company nyo sa amin,  nagbibigay ng incentive/commission ang hubby ko sa mga nag-re-refer, kapag nag-renew pa every year na ang incentive nyo. PM nyo lang ako.

[freeswan]

fyi lang mga sis, hindi nagrenew ang Maxicare sa Megaclinic in Megamall effective July 1, d na sila tumatanggap ng patients with MAxicare.

[AlexTin]

Hi sis, actually majority ng mga doctors accredited sila ng maraming HMO. Hindi lang sila specific sa iisang HMO. Katulad ng OB ko, dati akong Maxicare na naging MEDICard, since accredited sya pareho di na ako lumipat ng OB (at di rin pwede lumipat dahil sa policy ng Medical City). Sa pagiging competent ng mga doctor, nakakalungkot isipin bihira kang makakakita ng doctor na magaling na accredited ng mga HMO, kasi marami sa magagaling sa kanila ay ayaw magpa-affiliate kasi mababa lang ang binabayad ng HMO at minsan late pa silang bayaran. Ang reality kasi kapag affiliated doctor ka ng mga HMO, maraming ma-re-refer sayong pasyente, kaya ang mga simpleng doctor nagpapa-affiliate. Pero kapag alam mong magaling at kilalang doctor ka hindi ka magpapa-affiliate kasi kaya mong makakuha ng pasyente sa mahal na presyo.

Alam ko yan kasi dalawa ang OB ko, yung isa fertility doctor at specialist pa sa laparoscopy, hindi sya accredited dahil siguro sa tingin nya may sinabi sya... hehe Hindi lang kasi sya dito nag-c-clinic pati sa Singapore, at grabe ang bayad. Ni-refer sya ng isa ko pang OB na accredited ng maraming HMO dahil 7yrs na kaming hindi nagkaka-anak. Pero naging ok naman at nagka-anak naman kami kaya sobra din naman ang pasalamat namin kay specialist OB.

Dun naman sa affiliated HMO OB ko naman, para naman akong aatakihin kasi pakiramdam ko pineperahan kami. Imagine buong pregnancy ko ang dami kong Ultrasound at sa clinic mismo nya ginagawa, pero bawal yun kasi may sariling Wellness Center ang Medical City. Sa kanya rin kami bumibili ng vitamins at kada visit ko ask nya kung may vitamins pa, eh kahon-kahon kaya ang binibili namin kaya malabong maubos agad ang vitamins ko. Ngayon nga kahit nanganak na ako, pinapa-visit pa rin ako para sa ibang procedure at cervical cancer injection naman. Ok naman ang OB ko, super friendly at ok ka-chikahan, kaso di nawawala sa isip ko na lagi na lang kami pineperahan dahil nga libre lang ang maternity related consultation ko. Gustuhin ko man lumipat ng OB, hindi naman ako tatanggapin ng ibang OB dahil sa policy ng Medical City, hindi man ako makalipat kasi malapit lang sa amin ang hospital. Ayaw naman din i-reklamo ni hubby kasi maganda naman ang service nya lalo na nung makita ng asawa ko ang actual na panganganak ko, very professional. Mabait lang siguro ang asawa ko, sya ang kumakalma sa akin kapag na-e-HB ako sa OB ko.... hehe

Pero kung tatanungin naman kung sino sa mga HMO ang good payor at hindi late magbayad sa mga doctor, ang sagot nila MEDICard. Kaya wala sa HMO mismo ang problema nasa mga doctor na mismo. Kaya kung may mga reklamo, kailangan talaga gumawa ng letter which is mandatory naman sa lahat ng HMO at ang pinakamaganda ipadaan nyo sa agent.

Bakit ganun [textspeak!] mga doctors na accredited ng medicard more or less they are very incompetent. Just want to share a scenario and should be aware of.   I had my cyst (as per checking sabi sebaceous cyst daw) checked by one of the OB who is accredited by medicard (Makati Med) Dra. Ma. Liza Francisco, bigla nalang nya ako hiniwa (incise) near my genital area without my full consent.  No anesthesia then 3x niya akong hiniwa, the first time na hiniwa niya she said ay wala.. the second time hindi parin tumama then the 3rd time. She really seemed to know what she is doing.   Ang bilis ng lahat ng pangyayari, ang bilis bilis niyang kumilos grabe parang alam na alam [textspeak!] ginagwa niya..

After 3 days, when I touched my cyst and the incised area, I found out maling area [textspeak!] hiniwa niya and the cyst of course is still there. 

Please help, shall I get back to her for the follow up check up or just let the wound heal?!  Hay, ang sakit ng hiwa and the worst thing is, mali [textspeak!] part na hiniwa niya.

[ikaela]

Backread from page 1. Unang plan ko MAXICARE sana kaso ok lang for companies pero pag individual daming restrictions. Nalito na tuloy ako kung kukuha pa ba ako for me and spouse or better cash na lang pag may emergency na need admit sa hospital.

I'm looking for HMO na covered ang consultation, lab tests.

Read this entire thread too. I need an individual plan but after reading the reviews here, I feel like it's better for me to start my own health fund with the money I'll be using to pay the health card premiums.

Medicard, Maxicare and Blue Cross seem to be the best but individual premiums are 7k at the cheapest and that's with A LOT of exclusions. Consultations are excluded, diagnostic, x-rays and lab tests are exlcuded, and that doesn't even include a dental plan.

Lugi talaga pag individual.

[flexusob]

If the HMO card is company issued, the coverage would depend on the package approved by the company and it may vary depending on the position one holds in the company. Usually, maternity, infertility, and STD related procedures are not covered. Maternity consults lang puwede.

If you plan to get an HMO plan for yourself or your family, check the fine print and don't rely on the say-so of the agents who will even promise the moon just to close a sale.  Maraming restrictions ang HMO. Basically, for the first year, you can only get free consults but if you are going to have a procedure, it won't be covered. Their standard excuse - "pre-existing". 

If you are under an HMO, pansinin nyo what your OB writes in the diagnosis when she requests for a Pap smear for you. Oftentimes, it would be cervicitis or vaginosis or some other disease that you most probably don't have especially if its just the routine or annual Pap. This is because the HMO will not cover the Pap test unless there is a disease diagnosis. Hindi yan ico- cover kung ang diagnosis ay Normal. I used to hold clinic and sumasakit lagi ulo ko sa pakikipagdebate sa call center agent nila about this. The agent's usual answer is "hanapan nyo na lang po ng diagnosis".

Most doctors affiliated with HMOs are diplomates and fellows of their respective societies. They sign a contract with the HMO although some hospitals enter a blanket contract with the HMO to have all their
medical staff affiliated.  The contract doctors sign states (among other things) that they will see HMO patients, the relatively lower PF and consultation fees the doctor will receive from the HMO, and the reminder that doctors should not ask for any additional professional fees for procedures covered by the HMO. Doctors also get the HMO payments late, some after 3 months, 6 months, or worse, not at all. This is true for HMOs who have closed shop already. The payment due to the doctors wala na rin pag-asa makuha.

Sorry the post is long. Bottomline, read the fine print.  HMOs can be a big help, especially to employees. For individual plans, check the exclusions.

[iristacey]

i am happy na covered maternity. sa amin kasi hindi. at least namamaximize ko yung HMO benefit nila.

[ikaela]

^Sis anong card ang covered ang maternity? But oh well, I think pang-company yan, hindi ko pwede kunin kasi individual lang ako.

I read some more about Blue Cross, Maxicare and Medicard and you know what, I think Blue Cross individual plans actually give the most bang for your buck. For a 7,680 annual premium, they provide a huge 500k maximum coverage per year!

Sa Maxicare, a 10,800 premium only gets me 60k yearly per illness coverage while Medicard gives a 50k per illness per year coverage for a 6,767 premium.

May out-patient and dental benefits nga lang ang Maxicare and Medicard but ulimately, the reason why I'm getting health insurance is to protect me from a sudden and expensive illness that could drain me financially.

Kung dental at pa-check-up lang, e di much better that I keep my annual premiums and pay the dentists/doctors myself instead of having to get some approval letter or be limited only to the accredited ones.

[iristacey]

^medicard sis.

[ms.rain]

^^ i wanted to get blue cross for my father, hanggang age 65 nalang kasi ang maxicare nya.
but what's ultimately holding me back is isang tao lang kilala ko nag blue cross ever and ang saklap pa dahil hindi sila nakapag-claim. im not sure kung napost ko na yung kwento before, but to make the long story short, im pretty sure pag sa maxicare, medicard or intellicare nangyari situation nya, nakapagclaim pa sya.  if you have other feedbacks on blue cross, paki share naman... salamat.