Using A Us-Based Health Insurance Plan In A Private Hospital (Chong Hua)

[MikeeW]

The topic of health care and insurance is a regularly featured topic here. I thought I'd make a post about a surgical procedure at Chong Hua and the process for reimbursement.

The procedure was a simple surgery for hernia. The surgeon was fine, and had an office in CHH Medical Arts. After a brief office exam, the doctor provided a list of lab items to be completed and the name of a cardiologist who would do the clearance for the surgery. This process was time consuming and complex because it was all done as an outpatient. That means going to each area (radiology, lab, cardiology) and having certain processes done and reviewed. The results are commonly not available immediately, at least one day wait.

It was later learned that if the patient had been admitted to the hospital, the same processes would have been done, but the results could be available to the admitting doctor before the final report was completed. This means checking in, with the risk of being told the clearance is not to be given. However, the silver lining here is that whatever lead to the rejection was detected and now you know something else to have "fixed".

Once the clearance is obtained, the surgery is scheduled. The patient is admitted, gets a room, gets hooked up to the ever-present IV drip and begins the tedious process of being poked and prodded by every intern, nurse student and who ever walks in with a stethoscope. The nursing staff on the wards leaves a lot of room for improvement. I can comment on the inefficiencies/incompetences later.

The actual surgery is state-of-the art with attentive nurses and staff.

At admission, a deposit is made to cover basic anticipated costs. Having medical insurance based in the US has as much meaning to them as a "Get Out of Jail Free Card". Local insurance will make a difference, but others will have to comment on that. US-based insurance carriers may be willing to cover the costs, but they have no direct contact with Chong Hua. You are on your own for now.

That's where the heads up comes in. The money to pay the bills needs to be available at the time of discharge. In effect, pay or no discharge. There's the rub. Even though you could walk out with paying, you'd have no way to recover whatever moneys were spent since you'll have no discharge with receipts and such.

Others members may speak of using a promisary note. From what I know, it is a formal note involving a lawyer and fees. Conditions are collateral or co-signer. The co-signer needs to be someone they can chase after, so using your best friend banker in the US won't help. Collateral can be property, I guess. A car perhaps?

As in the US, the professional fees are separate from the hospital fees. You can pay the surgeon or others directly or at time of discharge. The discharge is a complex procedure, involving multiple copies of documents, several trips from the ward to the offices below. On the day of discharge, the resident doctor should have assembled all papers and the attending doctor just makes a final visit, signs off on most (some might get missed or forgotten so be attentive). If this happens after 1200 noon, there may be a surcharge for overstaying.

If you think this is being cheap, take a look at the detailed ledger (you have to ask for this and it is quite useful and extremely detailed). You will find that EVERYTHING is billed. Copies of documents are billed, meds are billed, lab work is billed, right down to the bandages used. They even bill you in the surgery recovery room for the cost of the small plastic cover used for the ear thermometer. That was 100 pesos as I recall.

After bills are paid and the guard gets the ever-so-pointless "blue copy" of the discharge papers, you leave.

Now, if you are lucky and all the info is present, you assemble everything, make your claim to your US-based insurance and wait.

There are several US-based companies that I know of, and each will have different features, so I can't speak to the details of each. The one I am familiar with takes about two months to return a check for what they will pay. You will already know what that should be. However, I wonder if they pay for the photocopying?

The real purpose of this post is to point out that the costs are basically yours until you get reimbursement. You may have an excellent plan covering many things, but you will need to shell out cold cash to get those benefits paid.

I might add that some expenses you may not think about need to be covered as well. The hospital expect you to have your own thermometer, bring your own water, have toilet paper if one roll is not enough, bring a bath towel and soap (none is provided), expect to buy food from the outside as the food is ALWAYS cold and usually pretty low quality. It is expected you will have a "watcher" who will attend to any needs you have.

More to tell, but this should be use to those who have questions about their nUS insurance

[earthdome]

I will be using a health plan for retiree's from my employer which will require me to pay up front then submit bills for reimbursement. I chose a plan that has high deductibles but allows me to use tax free money from an HSA to pay the deductibles and routine care costs for health, dental and vision.

Thank you for the detailed report. I was aware of some things but you provided many details I had not heard of yet.

One of the things on my list once I arrive this winter is to find some good doctors and my preferred hospital and start building those relationships right away to ensure when the time comes I can get the medical care I need.

[MikeeW]

Good plan to immediately get started with a physician. There is a distinct brotherhood among doctors here (though some backbiting as well). Sadly, doctors here won't offer much advice about the day to day details of how to handle the issues you face as a patient.

For example, I went to Cebu at the recommendation of a provincial specialist. He referred me to a Chong Hua affiliated doctor who would be the one to do the procedure. Simple, right? So,I go to the Cebu doctors office close to the time he sees patients. It was like a madhouse there. My wife tried desperately just to get the arrogant staff to even kook at her. It was hopeless. She finally was told to fill out a patient form and wait like the others. Fair enough. But, the doctor was going to be in his office for two hours, no more. She was given number 22.

We decided to go to.a hotel for the night. It was getting late, around 5pm, so we made a call to the provincial specialist. Luckily, his nurse allowed the call to be passed to him. Thankfully, he advised a simple, but odd solution. The Cebu doctor knew we were coming. He really didn't need us to come to the office. Just go to CHH and get checked in. That would require going thru the emergency room and there i got a complete exam. Two hours later I was in bed with the ever present I'VE.

The provincial doctor could have told us this before we went. But, as life is here, it all worked out.

Turns out, the Cebu doctor did see me that evening before the procedure the next day. It was at midnight, but I was glad to discuss it with him in advance.

If you get to know a doctor and especially if you can communicate by email or text, you are way ahead in the game of care for yourself.

[i am bob]

It's funny.... The long lines and long wait to see the doctor, not being told things in advance, poor / good quality of nurses according to where they are stationed... This sounds so much like what I have been through here in Canada. Even going through emerg to get to the doctor faster. So so familiar!

As for paying up front? I can't confirm this yet but I have been told that if I have PhilHealth as well as a registered Out of Country Health Plan (Insurance) that pays on the reimbursement system, you can pre-arrange with your doctor and hospital for the PhilHealth to cover your basics first (so you can get out of the hospital after) and then pay the remainder upon your OOC plan reimbursement. I"m not sure how that would work as you are suppose to pay the hospital before you can claim it. Perhaps they double-bill you and mark one paid?

Perhaps anyone if you are familiar with this can add to it - or let me know if this is bad information I had received? Be greatly appreciated!

Edited November 21, 2012 by I am bob

[Dave Hounddriver]

let me know if this is bad information I had received?

Every individual gets a different experience. You are right that the waits in Canada are sometimes longer than the waits in Philippines and for some treatments the user fee in Canada (where it is 'free') is higher than the full price in Philippines. Example, what I just paid for the baby's birth is more than the additional cost of a private room in a Canadian hospital so 'free' in Canada is pure BS.

So the information you have is sometimes correct and sometimes not. Depends on variables like what hospital, what doctor, what procedure, etc. The only sure thing is you WILL have to pay for all medications out of pocket from that first IV drip to the last aspirin. I have never see credit for medicine here but some bigger pharmacies (if you live in a town lucky enough to have them) will take credit cards. I know Mercury Drugs does and they are in most towns.

[MikeeW]

I understand the basic idea behind Philhealth. It does get you admitted with the hospital having assurances of some payment from Philhealth. However, with most gifts, there is always the unwrapping. Using Philhealth will require the claimant, you, to advise your US insurance carrier of the other insurance (Philhealth). Of course, your US carrier will want to be sure there is no duplication of benefits. I can only guess, but that means you will wait for Philhealth to do their calculations and make their payment before you get anything from the US carrier.

I chose to not use Philhealth for this reason. My relatives have Philhealth and have had long waits for compensation. As I recall, they actually paid the hospital bill and got a check which offset their cost. Kinda like with my US carrier.

My expectation is to have to pay all costs before I can make my claim. That is the main reason I posted to advise those who have this question.

As a sidebar, I was told Chong Hua was a Department of Tourism "approved" facility for medical tourism. Not sure of what that meant, I did some online research. There was really little info to advise a "medical tourist". Seems more like one of the great ideas here which never fully develop. This is in sharp contrast with other ASEAN countries offering programs of medical tourism. Loads of info and great details for countries like Thailand and Singapore on various websites.

A while back I made an inquiry to DOT medical tourism hospital in the NCR about some urgent surgery of the eye. It all seemed so great at first. Got a reply immediately to an email request. Got my query forwarded to no less than the director of the particular "institute" which handles such care. He was all helpful and courteous and advised he would forward my query to one of the resident staff. Just wait "for a while". The "while" became three days and when I followed up, I got all kinds of sorry, sorry. The resident had been on a sabbatical and I guess his boss didnt know that. Explains why no answer to my query. What it doesn't explain is how even the top facilities can screw up even the simplest of tasks. Micromanagement at its worst!

I am aware many of the complaints of the system here can be mirror images of the troubles in other western countries. It's just so much more fun here, right?

[Okieboy]

Philhealth Philhealth get it, a friend of mine had surgery at Doctors Hospital in Davao City the cost was P300,000 philhealth paid P200,000 and this was not a have to surgery, it was a problem to correct a female disorder so she can have children, if this had been an Emergency Surgery they would pay 80% and some medical issues they pay more, i don't know about Foreigners but filipinos can't be kept from leaving the hospital, they will have you sign a note for the remainder of the bill, i was involved in a case like this with my sister in law.

[i am bob]

I have a heat condition. And, yes, I might just keel over and die someday. Or not. But it is something that I have to keep on top of and be aware that I may end up in heart failure yet again someday. And that means hospitalization. So yes, I really do need medical insurance. Now, having sold insurance in the past, I am probably more aware of the ins and outs of the business than many. And for me, keeping the medical insurance I have here in Canada (which will cover 80% of all but hospital in the Philippines) is actually a poor choice. Why? Because the cost of insurance for an out-of-country member would be as high as or higher than replacing it with a local insurance plus PhilHealth. By about half. Am I going to replace it? No. Because my Special Someone and I have discussed our coming to Canada for a couple years - so that she can experience her chosen profession in a different setting as well as experience a different country setting. Once I drop this insurance, as a retiree, I cannot get it back when we come to Canada.

So, for those of you who are thinking of moving to the Philippines, if you are thinking of keeping your insurance from your home country, consider the following: First, is it cost effective or can you replace it with as good a plan for less money in the Philippines. Second, can you regain your insurance at home if you drop them? Are you sure you are not going to move back? If you do cancel and then decide to go back home, can you replace that insurance without losing your shirt along the way?

For most people, I would recommend biting the bullet and paying that extra charge (if there is one) for your home-country medical insurance for at least a few years. Until you are settled in comfortably, married (if in the cards), and happy to know you aren't going anywhere else. Sometimes this takes a couple years to figure out. Just an IMHO.... :tiphat:

[Okieboy]

An other thing if your here on a tourist visa, it would be hard not to have to pay up front, but if your permanent things go a little easer, as you have to have clearance to leave the country

[sjp52]

I have a heat condition. And, yes, I might just keel over and die someday. Or not. But it is something that I have to keep on top of and be aware that I may end up in heart failure yet again someday. And that means hospitalization. So yes, I really do need medical insurance. Now, having sold insurance in the past, I am probably more aware of the ins and outs of the business than many. And for me, keeping the medical insurance I have here in Canada (which will cover 80% of all but hospital in the Philippines) is actually a poor choice. Why? Because the cost of insurance for an out-of-country member would be as high as or higher than replacing it with a local insurance plus PhilHealth. By about half. Am I going to replace it? No. Because my Special Someone and I have discussed our coming to Canada for a couple years - so that she can experience her chosen profession in a different setting as well as experience a different country setting. Once I drop this insurance, as a retiree, I cannot get it back when we come to Canada.

So, for those of you who are thinking of moving to the Philippines, if you are thinking of keeping your insurance from your home country, consider the following: First, is it cost effective or can you replace it with as good a plan for less money in the Philippines. Second, can you regain your insurance at home if you drop them? Are you sure you are not going to move back? If you do cancel and then decide to go back home, can you replace that insurance without losing your shirt along the way?

For most people, I would recommend biting the bullet and paying that extra charge (if there is one) for your home-country medical insurance for at least a few years. Until you are settled in comfortably, married (if in the cards), and happy to know you aren't going anywhere else. Sometimes this takes a couple years to figure out. Just an IMHO.... :tiphat:

Two things I can add for Canadian citizens are that ohip pays up to $5000 / year any where in the world and you can be out of the country for 7 months and still keep ohip. If you are out of the country for more than 7 months you lose it and need to reapply. There is a 3 month waiting period before you can make a claim once you are reinstated.