all about HMO

[ikaela]

^Same here. I really like that Blue Cross offers the biggest coverage for about the same amount out of all the HMOs I researched on. But I haven't heard a lot of feedback on them. The one thing I did come across was from a guy complaining that they increased his premiums to like 300K after he was diagnosed with a dreaded disease. The rest were okay I guess - about how quickly they were reimbursed for their expenses and etc.

Hope someone can share more info on Blue Cross. And what exactly do they cover and NOT cover? I'm not sure what their policies are regarding minor injuries/illnesses and vehicular accidents. I can accept that they don't cover dental and preventive care, but they should at least be able to cover things like broken bones, burns, infections, animal bites and etc.

[swit_squiggle]

one insurance company i know offered a hospital income benefit which you are being paid 3 days minimum and 1000 days to the max. with 500 to 2000 income bracket. with another benefit na kung madiagnose ka ng critical illness the company will pay you half the face amount you chose.if you are insured for 1M bibigyan ka ng 500K. meron din silang pambabae na benefit na covered ang hospitalization pag manganak at sakit na pambabae.

[ikaela]

When you make a huge claim from Maxicare or Medicard, do they increase your premiums the next time you renew your policy with them?

[yaelski18]

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.

This makes me curious about FortuneCare's setup. FC cardholder kasi ako. FC has its own clinics and usually nagpapa-checkup ako sa Manila clinic nila dahil malapit sa opisina. I'm guessing they are okay there, since tuwing pumupunta ako laging maraming pasyente and wala pa naman akong na-encounter na pasyenteng nagwala o na-high blood dahil sa doktor o serbisyo ng staff. I usually also do not pay anything there except for the medical certificates I had to ask (P50 per certificate) and the blood typing procedure (di raw covered ng plan ko).

[AlexTin]

When you make a huge claim from Maxicare or Medicard, do they increase your premiums the next time you renew your policy with them?

Yes, especially if your plan is for individual. That's why my husband doesn't offer HMO to individuals lalo na sa may edad o may pre-existing condition, lugi sila at nakakaawa kapag gagamit na, kasi konti lang ang makukuha.

[ikaela]

^Thanks for the honesty AlexTin. Siguro kuha na nga lang ako ng medical insurance. At least malaki-laki yung coverage (500k) for minimal cost (6k). Hanggang di pa nakakaipon for self-insurance, at least meron masasandalan na malaking amount. Then cancel ko na pag nakaipon na or pag nagamit and nag-increase ng todo yung premium.

[lencute]

how about medocare?

[swit_squiggle]

 sa Life insurances with attached Critical Illness Benefits and Income Hospitalization + investment.sa huli parang ang kita na ng investment mo ang nagbabayad sa charges. wala ka nang binabayaran.

[marssie]

Yes, especially if your plan is for individual. That's why my husband doesn't offer HMO to individuals lalo na sa may edad o may pre-existing condition, lugi sila at nakakaawa kapag gagamit na, kasi konti lang ang makukuha.

Naku kung ganon ano kaya ang magandang insurance para sa parents ko, 60plus na pareho nanay at tatay ko and im bad na ngayon ko lang naisipan sila kuhanan ng insurance for some financial reasons din kung bakit late

[swit_squiggle]

if they are still insurable they will be paying higher premium because of their age.

[genericme]

When you make a huge claim from Maxicare or Medicard, do they increase your premiums the next time you renew your policy with them?

I suppose they do. I know someone who claimed from his HMO (Blue Cross) after a major illness. The next year, there was a huge mark up in his premium. According to Blue Cross, the adjustment in premium was made as a result of his claim. It's as though the person was penalized for falling ill. It seems unfair but that's the way it is. It's a business.

[genericme]

Meron ba dito sa Pinas na parang health savings accounts sa States? Parang investment lang din where the money rolls over and accumulates year to year if not spent, but you still get the benefits of a regular HMO?

Ang alam ko, Caritas Health Shield offers something like this. It's like a money back guarantee. The way I understand it, they pay you a certain percentage of your total contribution after a certain number of years. Parang savings/investment daw. I received a text kasi from them so I called to inquire. It seems like a good deal but the premiums are way too costly for me.

[swit_squiggle]

meron ito almost everywhere sa mga HMO's and insurance companies that in the event hindi mo magamit merong return of premiums na 50% or 75% but not the whole amount you paid. its costly rather.

[ann1203]

Sis, better check kung totoo yang 70% na yan, remember, pre-need companies are getting short of cash na.

I was a former cardholder of caritas. We only availed of their services for a year. Hindi kami masaya. The accredited doctors are ok, but the service of caritas itself, it sucks.

Hindi respectful ang mga frontliners (customer care) nila. Eh, everytime magpapa-check up ka, you have to go there to get an LOA form. Sa isang taon kong kliyente nila, wala akong maalala na kahit isang beses na binati nila ako ng "Good Morning" or "Good Afternoon". Yung iba, pag-upo mo pa lang nakasimangot na.

Maraming clients nila ang hindi happy sa service nila (based on dun sa mga nakaka-kwentuhan ko sa mga clinic nila).

I suggest you go for the bigger names in the HMO industry.

korek ka jan sis! kaya hindi ko na rin nirenew plan ko sa caritas karamihan sa kanila bastos... pro sa cubao branch nila mababait... sa cainta ang grabe as in hndi ka nila iintindihin wala cla gnawa kundi magtxt, grabe!

[paige830]

Meron po bang Health Insurance na nag-aaccommodate ng patients above 60 years?

[zanabee]

sis is the health insurance na pwedi kong i apply ang mga parents ko though i'm already married? please help...

[ilurvepeanutbutter]

We're using Medicard sa office.

[pompz]

dati akong member sa fortune care since 2003 group plan kami nag start kmi from 280 ata yearly nag iincrease ng 100 until now 790 na, inistop ko na since nag preggy ako kasi di ko din naman magagamit and i don't have any plan to use it hehe mga sis, pero kailangan talagang may HMO dahil every consult mo is 1k, hays sobrang mahal, naghahanap ako ng HMO na pwede mga anak ko na minimum lang can u give ideas how much? kasi sa fortune don ka lang sa clinic nila sa fortunecare clinic ka lang papacheck up. .. TIA

[nikki21]

question mga sis. meron kami health insurance dito sa company namin.kaka sign lang namin.pano po kung gusto ko din magamit yun ng mother ko in case. lalagay ko ba sya as dependent? and may babayaran ba ako dun?

thank you

[karizza]

ask ko lang mga sis, ano yung pinaka mura at magandang HMO pag mag aapply ako as individual?