Ryan J. Abuel / I am complaining about philcare reimbursement and claims no update for 3 weeks now

1 Makati City, PH
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I would to like file a complaint about liaison office and customer support representative that I have spoke to with regards to hospital bill that I have paid 65 thousand pesos on top of my son's Philcare coverage.

Excess 65 thousand of hospital bill because of PHilcare Liaison officer and Customer support's wrong and changing coverage limit. I should not have confined my son in Paranaque hospital in the first place if ever that I know my son's card limit. I have call Customer support of philcare 5 times asking for my son's coverage limit at first they said i have approximately 40k of limit left because my son was hospitalized last January 18, 2017. I know that calls are recorded and you have the authority to investigate. I already have filled a complaint form in Philcare gateway portal and waiting for email coming from Mr. Chad Benidict.


Last January 18, 2017 My son Al- Khalil Shane Abdulla Abuel was confined to UHBI-Paranaque Doctors Hospital for ca bike accident resulting to fracture 4th digit Left Hand S/P open reduction + pinning. That resulted to 71, 925.62 hospital bill and Philcare coverage was 53, 501.32. I have send a request of reimbursement to Chad Benidict and was declined ( fair enough and I acknowledge it). Now it should be a simple removal of the pin from the last operation that supposed to be scheduled last March 3, 2017. Because of the delay since my Philhealth according to the hospital was not updated I immediately provide the requirements unfortunately 3 days delay of the removal of pins caused infections and an immediate confinement to Paranaque hospital. As per HMO representative in the hospital prior to admission says they called Philcare for approval and the liaison officer said that it is a go signal for admission since it is still covered and will follow up on the hospital for the amount of the coverage ( well in the first place they should have inform me that this amount??? is what is left and what will be covered since they know what operation type will be done so they will have the accumulated coverage not at the end wherein the bill is already served wherein card holder will face the hardship of finding money to cover up the incompetence. If ever that I know that this is the only coverage well of course I should not have bring my son to the accredited hospital by philcare instead i should have bring him to orthopedic in Manila wherein believed me will not cost 65k from my own wallet. Let us do some math here to easily picture what is going on in this very long story.

First coverage of Philcare = 53, 501.[protected] for coverage = 46, 498.68 - remianing
Well we came back to hospital for follow up check up
1- xray = 700 accumulated price
2- consultation = 2000 accumulated price for check up only
so if we subtracted this to the remaining 46, 498.[protected] = 43, 798.68 = remaining - ( this is the customer representative of philcare that I called 5 times is saying. check the recordings please...) Liaison officer said the first initial coverage was 9700 and I was shocked. then he told me that he will investigate what happen and will re calculate then said he adjusted again the bill to a total less of 20k and it is final. And as I remember on my 3rd call to the customer representative of philcare he said that "last time we check it was 55k that your son was already used on his card and now it goes to 65 k, i see here that it was an xray and 2 consultation and I'm also surprised why this is very expensive don't worry sir i will make a notation out of this" So liaison officer is manipulating the expenses???? what does this statement means?

I also figure that the Professional fee do increase dramatically from the last operation

January 18, 2017 - combined professional fee by two doctors for left hand operation with pinning = 7, 560 which I believed is much expensive and more difficult operation versus unpinning and removing infection

March 8, 2017 - combined professional fee by two doctors for left hand unpinning and removal of infection = 46, 800
I ask the admin of the hospital and the billing OIC and said that it is the liaison officer of philcare that is designated in the hospital is the one providing the quotation for the Doctor's professional fees. Hmmm seems suspicious why it is too big compare to the last operation.

Now I do believed that I'm entitled for a reimbursement here amounting to 20 thousand pesos here. Please do understand my situation 20 thousand for a family man like me is too big.

I will appreciate if you are going to investigate what happen here and I'm very understanding person if only you will explain to me every questions that I have written here. If you said that is the coverage and the agreement that I have signed for then so be it but then you should have a representative to explain every card holder regarding the benefits and coverage so that we are aware. I'm not in to comparison but sadly speaking I have medicare and Intellicare before and it was more convenient and easy to avail and used.

To: Lorna F. Recayo; Hazel N. Evangelista; Richard I. Argarin; Chad Benedict L. Ros; Teletech Claims

Mar 26, 2017

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