Health Insurance, Pre-existing Conditions, Cost, and Games

[KenM]

For a year when I first came to PH I had Geoblue insurance. As a U.S. based company they don’t exclude any pre-existing conditions, so they claim. I paid over 5K in premiums that year and they reimbursed only $400 most of which was routine medicine. They should have reimbursed $1400. They played games for example if a doctor rents an office in a hospital complex, like most do, they count that as a hospital visit and apply the hospital deductible. Even though these are private doctors. They insisted on diagnostic codes to cover treatments. Doctors and hospitals here don’t provide that. And they would not listen to reason as the objective was to bilk. 

I’ve read accounts of other providers bending over backwards in the Philippines to consider things pre-existing even if they were new diagnosis. So people were not covered in the end.

I’m hoping to hear from folks who have actual experience with different providers. I would like to find insurance that won’t have preexisting exclusions, won’t play games, and will be reasonable. It’s my understanding that Philhealth is next to useless for foreigners now that everything major is excluded. Thanks, Ken

Edited May 26, 2023 by KenM

[Viking]

1 hour ago, KenM said:

I would like to find insurance that won’t have preexisting exclusions, won’t play games, and will be reasonable. 

That's almost the same chance as finding a unicorn, but if you find one, it will probably be very expensive.

 

[KenM]

To clarify, I have read accounts of insurance calling things pre-existing that are not and therefore not covering anything significant. I have also read mention of insurance that allegedly does not exclude after a period of time. I’m hoping to hear serious feedback from member who have actual experience. With insurance that did or did not pay claims. That did or did not play games like asking for diagnostic codes from a routine doctor visit. 

[MikeB]

9 hours ago, KenM said:

I’m hoping to hear from folks who have actual experience with different providers.

I had a major claim as a result of an accident with a Philippine insurer (Blue Cross Philippines, now Pacific Cross) of somewhere between p1million and 2 but that was over 10 years ago and did not involve pre-existing so I won't go into all the gory details because they've been recounted here previously and not sure they would be relevant to present time or your situation. But, bottom line, they paid virtually everything and I was very glad I had the insurance. You're wise to be checking these things out.

9 hours ago, KenM said:

It’s my understanding that Philhealth is next to useless for foreigners now that everything major is excluded.

It was basically a discount when I was there, not insurance. Cheap though, better than nada.

[hk blues]

13 hours ago, MikeB said:

It was basically a discount when I was there, not insurance. Cheap though, better than nada.

As far as I'm aware it has always been a discount only scheme and is not intended to cover the full cost of treatment - this applies to locals as well as foreigners.  

We have used it a few times and it more than pays for itself with even just one treatment a year. 

[OnMyWay]

20 hours ago, hk blues said:

As far as I'm aware it has always been a discount only scheme and is not intended to cover the full cost of treatment - this applies to locals as well as foreigners.  

We have used it a few times and it more than pays for itself with even just one treatment a year. 

Yes, but an added benefit that is not quite so obvious is that Philhealth reviews the charges and will not allow over a certain amount for each item.  That is a big benefit for the patient, especially a longnose! 

[hk blues]

3 hours ago, OnMyWay said:

Yes, but an added benefit that is not quite so obvious is that Philhealth reviews the charges and will not allow over a certain amount for each item.  That is a big benefit for the patient, especially a longnose! 

Indeed - another benefit that I hadn't really thought much at all about.

[mountainside]

Ken, I think the reason you haven't had many specific responses is that forum members here don't carry Philippine health insurance aside from PhilHealth.  The risk/reward ratio for private Philippine health insurance doesn't make sense, especially for older folks like many us are.  Many of us have health coverage in our home countries, which some of us use when in our home countries.  But medical insurance in the Phils for most expats essentially boils down to self-insurance (or as some would say, no insurance).  I accept that as a fact of life. 

Your understanding that PhilHealth is "next to useless for foreigners" is a mistaken understanding, in my opinion, and I think the opinion of previous commentators.  I emphasize with your frustration.  I've been there myself.  Good luck with your research, and please let us know if you find a health plan that makes sense for foreigners in the Philippines.     

[OnMyWay]

40 minutes ago, mountainside said:

Ken, I think the reason you haven't had many specific responses is that forum members here don't carry Philippine health insurance aside from PhilHealth.  The risk/reward ratio for private Philippine health insurance doesn't make sense, especially for older folks like many us are. 

A lot of expats in the Angeles City Expats FB group I am in seem to buy health insurance.  I would say they do tend to be slightly younger than the old farts on this forum, which may make the decision easier.  Many buy from an expat agent selling Pacific Cross, who seems reliable and honest.  I have chatted with him and might consider him for Pacific Cross if I stay in PH.  Yes, there are limits for older people.  If anyone wants his name, PM me.

[Jack Peterson]

11 minutes ago, OnMyWay said:

I would say they do tend to be slightly younger than the old farts on this forum, which may make the decision easier. 

 Fine way to talk about your fellow members here