Beware of scams in HMOs: What to Ask from your HMO

In today's stressful working conditions and competitive working atmosphere, it is common for people to suffer from different ailments ranging from simple to complicated.   And most employers recognize this fact especially if they are aware of the long-term illnesses that are developed from working with them, that is why a medical benefit is one of the things employers dangle to their prospective young employees.  Now, I have nothing against HMOs,  I recognize the necessity of their products.  However, some HMOs really are not reliable.  Marketers aggressively sell them, make untruthful sales pitches just to get you to sign up, after signing you up, problems start to surface.

Take Orly (fictitious name) for example, he is a diabetec and his doctor advised him to get an HMO, in anticipation of a long haul.  He was approached aggressively by a 'health counsellor' from a not-so-established HMO (This HMO is not so popular yet)  this not-so-established HMO showed promise when the health counsellor explained its features.   Not only was it an HMO, but also a savings plan:  5 years of paying, but plan holders can use the card and its privileges for 10 years and to top it all, the card holder gets back 100 percent of the total amount he paid.   Sounds great, yes?  Orly was very impressed and gave them his credit card.  Little did he know that this not-so-established HMO would swipe the card for him to pay the yearly premium in one big payment of 60,000+.  Orly was so shocked upon receiving his bill for the month and thought, How in God's name did I incur such a huge amount of payable?  Only then did he realize, and without his authorization, he was going to pay the entire 60,000 in one whole swipe, while during the explanation of the health counsellor, only P5,000+ a month sir...if that isn't an unfair practice, i don't know what is.  

Now, here are some things to consider if you are planning to get an HMO, especially if you are not employed.  Because  believe me, most doctors are very choosy with HMOs, like Orly's doctor.



1.  Do they cover lab requests by doctors?  And if they are selective of it, put in black and white, those that are not covered.  Orly's doctor requested for a blood work up for his diabetes, (note that this not-so-established HMO, specifically stated that pre-existing conditions are covered even during the first year of membership.)  HMO only covered  FBS and CBC...the cheap ones...and so Orly ended up paying P5.7 in St. Luke's.  This after paying P60,000 of premium.


2.  Will they reimburse doctor's fees from doctors that don't accept their card?  Orly's doctor is very picky, but there is no way Orly will change his doctor just because picky-doctor does not accept not-so-established HMO.  Orly's doctor charges P1,250 per consultation which is really high compared to others.   Will not-so-established HMO reimburse Orly?  Only God Knows.

3. If the HMO does not have a land line, that is a red flag.  How can an establishment, a business which is legitimate, cannot have a physical office and a landline?   Second, are most of their officers reachable by cellphones only?   Third,  if they don't reply even by email,  then something is not right.    

  

Be Vigilant:

Orly's picky doctor only accepts Intellicare, and I understand why.  Intellicare has a very efficient officer in the concierge of St Luke's.  I am not surprised why Intellicare is the best HMO in the country and the choice of employers.  I personally have seen how much they take care of the patients and their cardholders, giving sound advice as to what kind of room to select and to what doctor to consult with.   They follow up their  patients, even checking them up in their confinement.   


Life is very challenging lately, so let's be vigilant about scams from these HMOs. Always, always let your HMO explain their resistance to your requests and preferences.