October 21, 2008
Atty. NICOLAS B. LUTERIO III
Director IV
Bureau of Health Facilities and Services
Department of Health
Building 15, San Lazaro Compound
Rizal Avenue, Manila
Subject: CARITAS HEALTH SHIELD INC.
Dear Sir:
I would like to file a complaint against the above mentioned HMO based on the following grounds:
I am 53 years old and a holder of their expanded health plan since 2006 with an annual premium of P23,500.00. Photocopy of health card is attached.
Since 2006 until October 18, 2008, I have not filed any claim for any health benefit under my health plan.
Last Sunday, October 19, 2008, I suffered an accident injuring my left foot causing tendon injury that required wound exploration, operation and one-day admission at Mary Johnston Hospital.
When I was brought to the ER of the hospital at around 11 a.m., the hospital staff called the Caritas informing them of the incident and the procedures that would be applied to me. The other end of the line told the staff that Caritas will not pay for my admission, only the expenses as out-patient. Later, the doctor talked to the Caritas staff on the phone and insisted that I should be admitted. After several arguments, the Caritas personnel agreed and promised to process the Letter of Approval (LOA). Hospital staff even gave comment that they are always having a hard time in dealing with Caritas. “Mahirap talaga mag-follow-up sa Caritas, parang ayaw talagang magbayad” as what the staff stated.
We spent from 11 a.m. to past 2 p.m. just waiting for the ‘GO’ signal of Caritas. I was admitted and operated around 3 p.m.
The following day, Monday, October 20, 2008, I was shocked receiving the call on my mobile phone around 3 p.m. from Caritas informing that my hospital bills amounting to nearly P11,000 plus professional fees of P5,000 will not be shouldered by Caritas, due to some technicality.
The technicality was that I was not able to declare that I was hypertensive and they said that such is a ground of disallowing my claim. What is the connection of this wound injury to being a Hypertensive? And to add insult to the injury the Caritas representative went to the hospital and did not even bother to see me but instead went directly to the Billing Section of the hospital and told Billing Section Personnel that Caritas will not pay my bill. The Caritas representative also did not even bother to see the Caritas coordinator of the hospital. It was almost 5 p.m. and we were rushing to find money to settle the bills on our own.
I was unaware of this technicality when I filled up the forms and the consequences it will bring. I was MESMERIZED by their ‘heavenly’ window-dressed presentation during that time.
I was in good faith in paying these premiums for 3 years amounting to almost P72,000. I believe that there was deception in this practice. I believe that I deserved what I have paid for. What is my coverage NOW? Even a one-day confinement due to tendon injury is NOT COVERED. Even headache is not covered, I assume. What did I paid for P72,000? The plastic health card ID which is useless.
I demand full refund of my contributions and termination of this health plan immediately with the help of the proper government authority.
I am a taxpayer and one of the working class that will not bother and depend on the government for employment, food and medicines. I prepared myself and my family for untoward incidents in the future. One of these preparations is acquiring a Health Plan to take care of hospitalizations if ever. Unfortunately, I end up with Caritas. They can say that it is ‘technical’ but it is not moral to rob some taxpayer of his hard-earned money who is in good faith choosing to invest for his future health care needs.
Talking of technicality, attached is a 2004 article, “THE SECURITIES and Exchange Commission (SEC) has asked the Department of Health to address complaints involving medical service provider Caritas Health Shield Inc. (CHSI)….” which is self-explanatory. It showed that Caritas is using ‘technicality’ to bend and go around government regulations. I hope that the concerned government agencies will dig deeper into this.
All I am asking now for the government and its agency concerned is to help me save my hard-earned money from vanishing in air due to this organized, well-planned DECEPTION hidden in the word of ‘technicality’.
Thank you and hoping that your office will implement immediate appropriate action on this matter
Very truly yours,
ROLANDO J. RELOS
Plan Holder
Atty. NICOLAS B. LUTERIO III
Director IV
Bureau of Health Facilities and Services
Department of Health
Building 15, San Lazaro Compound
Rizal Avenue, Manila
Subject: CARITAS HEALTH SHIELD INC.
Dear Sir:
I would like to file a complaint against the above mentioned HMO based on the following grounds:
I am 53 years old and a holder of their expanded health plan since 2006 with an annual premium of P23,500.00. Photocopy of health card is attached.
Since 2006 until October 18, 2008, I have not filed any claim for any health benefit under my health plan.
Last Sunday, October 19, 2008, I suffered an accident injuring my left foot causing tendon injury that required wound exploration, operation and one-day admission at Mary Johnston Hospital.
When I was brought to the ER of the hospital at around 11 a.m., the hospital staff called the Caritas informing them of the incident and the procedures that would be applied to me. The other end of the line told the staff that Caritas will not pay for my admission, only the expenses as out-patient. Later, the doctor talked to the Caritas staff on the phone and insisted that I should be admitted. After several arguments, the Caritas personnel agreed and promised to process the Letter of Approval (LOA). Hospital staff even gave comment that they are always having a hard time in dealing with Caritas. “Mahirap talaga mag-follow-up sa Caritas, parang ayaw talagang magbayad” as what the staff stated.
We spent from 11 a.m. to past 2 p.m. just waiting for the ‘GO’ signal of Caritas. I was admitted and operated around 3 p.m.
The following day, Monday, October 20, 2008, I was shocked receiving the call on my mobile phone around 3 p.m. from Caritas informing that my hospital bills amounting to nearly P11,000 plus professional fees of P5,000 will not be shouldered by Caritas, due to some technicality.
The technicality was that I was not able to declare that I was hypertensive and they said that such is a ground of disallowing my claim. What is the connection of this wound injury to being a Hypertensive? And to add insult to the injury the Caritas representative went to the hospital and did not even bother to see me but instead went directly to the Billing Section of the hospital and told Billing Section Personnel that Caritas will not pay my bill. The Caritas representative also did not even bother to see the Caritas coordinator of the hospital. It was almost 5 p.m. and we were rushing to find money to settle the bills on our own.
I was unaware of this technicality when I filled up the forms and the consequences it will bring. I was MESMERIZED by their ‘heavenly’ window-dressed presentation during that time.
I was in good faith in paying these premiums for 3 years amounting to almost P72,000. I believe that there was deception in this practice. I believe that I deserved what I have paid for. What is my coverage NOW? Even a one-day confinement due to tendon injury is NOT COVERED. Even headache is not covered, I assume. What did I paid for P72,000? The plastic health card ID which is useless.
I demand full refund of my contributions and termination of this health plan immediately with the help of the proper government authority.
I am a taxpayer and one of the working class that will not bother and depend on the government for employment, food and medicines. I prepared myself and my family for untoward incidents in the future. One of these preparations is acquiring a Health Plan to take care of hospitalizations if ever. Unfortunately, I end up with Caritas. They can say that it is ‘technical’ but it is not moral to rob some taxpayer of his hard-earned money who is in good faith choosing to invest for his future health care needs.
Talking of technicality, attached is a 2004 article, “THE SECURITIES and Exchange Commission (SEC) has asked the Department of Health to address complaints involving medical service provider Caritas Health Shield Inc. (CHSI)….” which is self-explanatory. It showed that Caritas is using ‘technicality’ to bend and go around government regulations. I hope that the concerned government agencies will dig deeper into this.
All I am asking now for the government and its agency concerned is to help me save my hard-earned money from vanishing in air due to this organized, well-planned DECEPTION hidden in the word of ‘technicality’.
Thank you and hoping that your office will implement immediate appropriate action on this matter
Very truly yours,
ROLANDO J. RELOS
Plan Holder
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