I am writing about an experience that we
had with INTELLICARE when my mother was
hospitalized on the 22nd of October 2012 in Commonwealth Hospital
and Medical Center. She was scheduled by her physician for a cholecystectomy
operation due to gallbladder polyp the next day but confined that day for
monitoring since she has DM Type 1.
Problem started when HMO personnel of the
hospital called IntelliCare for approval of my mother’s expenses prior to
admission since she has P90, 000 hospitalization limit on her plan. With an
IntelliCare agent on the other line, the HMO assistant who’s conversing handed
the phone over to my sister and I can spot right away that there is a problem.
My sister after a minute handed me the phone, the IntelliCare agent initially
told me that they will only answer P8, 000 on the total bill if she’ll be
confined. He then proceeds asking me if it will be a “lap or open?” which I
guess the same question he’s asking my sister a while ago that she cannot
possibly understand. I answered him back if there will be difference on their
coverage should we opt for laparoscopy. He replied that same coverage; maximum
of P8, 000 will be given. I didn’t know why he’s still asking since on their
end they will be answering the same amount and at the same time, it was clearly
“cholecystectomy” which is an open surgery, maybe for some sort of
documentation so I just let it pass.
Moreover, since Gallbladder Polyp is a [i]pre-existing
condition we’ve been informed that we can call the HR of my sister’s company
for further information. I myself have an IntelliCare handbook from my previous
employer and give it a quick scan while my sister immediately called their HR.
She couldn’t connect and after several tries she chose to give it a break and
we had our lunch. She was able to contact the HR department around 2PM and the
most we could get as a response for having waited that long is to call
IntelliCare again and HR staff said that based on IntelliCare it was a
pre-existing condition.
My family decided to still have my mother
admitted and her operation to push through the following day and just deal with
IntelliCare and TELUS HR afterwards because it’s becoming too much of a stress.
We cannot jeopardize my mother’s health just because IntelliCare offer minimal
help (due to their pre-existing condition clause) and wait for HR’s explanation
regarding that matter. At that time, I already read that very little
explanation about “PEC’ in the booklet and just hope to talk to the liaison
officer to shed some light because we were advised that he will be visiting us morning
of the following day.
October 23, 2012, 2nd hospital
day my mother’s operation started at 6 in the morning and she was already brought
back to the room at around 11 in the afternoon. Our whole family was there but
no representative from IntelliCare has dropped by. My sister who was paying for
the card wanted to talk so badly with the IntelliCare agent that’s why even
when she was from night shift the day before, she stayed in the hospital. My sister
(needs to go to work that night again) and I (not having enough sleep) went
home late in the afternoon and just told my father to have the agent from
IntelliCare leave his number so we can still talk to him if by any chance he
will visit my mom. At past 4PM or almost 5PM, an IntelliCare representative
came according to my father. Since my father was not that knowledgeable about
these things he asks the agent for his number. This liaison officer left two
contact numbers, and for God’s sake they are both HOTLINE numbers! He didn’t
even introduce or gave out his name to my father. FRUSTRATION is an
understatement, it’s UTTERLY DISGUSTING.
October 24, 2012, I’m the lone watcher of
my mom and while she’s sleeping I tried calling the number on the back of
IntelliCare card which is noted as Head Office number (one of the numbers that
the liaison officer gave). To give you an idea about my conversation with Ms.
Cecil, she started the call by getting information for verification. Then, I
informed her that I call to vent my sentiments. I suppose she has all the information
after I gave out my mother’s card number, because she was like, nasa Commonwealth Hospital...Pre-Existing
Condition...10,000 ang maximum coverage pero 8,000 lang kasi yung remaining for
follow-up check-up...company contract...HR department...orientations and so
on and so forth. I then asked her to please explain more about the pre-existing
conditions and she answered me back with a clause from a note that she might be
reading somewhere. She then goes on with, since
ang sakit eh sa gallbladder...ang stones nadedevelop... I honestly couldn’t
remember her exact words but she just lectured me of the pathology of cholelithiasis (gallbladder stone) which
she might be reading from the internet or some other source.I tried my best not
to interrupt her with the lecture. I am
a very tolerant person but I believed I had enough to ignite my anger. I tried
to remain calm and control myself. I told her that my mother’s diagnosis is gallbladder polyp and not stone. I just asked her again, can you
please explain further the definition of “PRE-EXISTING CONDITION”, this time
she answered something like “diseases/illnesses
that occurs through time”. I told her that was too vague for a definition,
if she can give me additional insight about that “occurs through time”
statement. No definitive answer given to me. She has to practice more of
empathy because she doesn’t sound sincere when she gives out her empathic
statement especially when I ask her, “kung
ikaw nasa ganitong kalagayan, bakit mo ikukuha ng health card ang mga parents
mo?” She answered questions as if it was scripted. She even enumerated the
times my mother was able to use the healthcard just to show me that she was
able to use the card. In fact that single consultation at Bernardino Hospital
has its own story. My mother has a non intellicare-accredited diabetologist
requesting for laboratory tests, she went to that hospital and asked if she
could use her IntelliCare card. She was referred to a pulmonologist just to
have a request for lab from an IntelliCare accredited physician so the
laboratory test will be covered. Well, enough said about that and going back to
the conversation I inquire again, “ano
ang kinocover nyo ng hospitalizations? Emergencies?” “Yes!” she replied I bombard her with questions, “accidents?”yes! “What else?” Infection! I
wanted to ask her, what they do if an infection occurs through time but I decided not to because it might seem
sarcastic. I just followed up, “kung
nadiagnose ang mother ko maybe next year, magkano ang icocover nyo?”
Ms.Cecil urgently answered, “same pa
din...pre-existing pa din”. I told
her at that point “Sige na Ma’am tama na, kasi parang naglolokohan na tayo.” That’s
how the call goes and if the agent explained things to me? Well, she explained
a lot, but if she was helpful? I leave it to the reader.
The IntelliCare statements always leave us
with more questions rather than answers. Too much gray area leads to more confusion.
And in the end the cardholder suffers from the contract between the IntelliCare
and the Company which they are not aware of. Moreover, my sister trusted and
relied too much with the HR for caring for the employees’ well-being and to be
there for assistance especially during tough times. But who does the job? And
since everyone is pointing their fingers to one another, we’ll find other
avenue or forms of media to let the public know just like how IntelliCare find
their leeway to a given situation.
IntelliCare would insist on the contract
about pre-existing conditions and will refer you to HR department of your
company.When my sister request for help from HR they will then go back with
IntelliCare and cannot provide you an answer. As if they were signing an
agreement including “pre-existing conditions” with their eyes closed. So how’s
the orientation done by IntelliCare? If my sister wasn’t able to attend the
orientation why these HR personnel couldn’t explain these things to my sister?
How will you expect an employee to understand about these PEC when the HR
themselves did not understand it in the first place and always check with
IntelliCare one essential part of the contract?
What if these things happened not to us
but to you or your family member? What if there are no savings to have your
relative operated and you rely solely on your health card? I tried to think
that this is an isolated case but it hurts more because it’s my mother’s health
that we’re talking about. Health should always be taken seriously, and LIFE is
PRICELESS.
After a week had passed, INTELLICARE and
TELUS HR are still going through these and that. Going back and relating this
incident over and over again is exhausting as if adding insult to the injury. What
these people certainly don’t understand is that, it’s not all about the money.
It is the SERVICE that my mother DESERVED and what my SISTER has been working
and PAYING FOR! One visit, One Call would have changed it all. But what we have
was NOT EVEN a HINT of CONCERN from these people. As if, we are asking for too
much FAVOR from them. We are not mere EDUCATED individuals, we are
professionals and we should at least be treated PROFESSIONALLY. I wanted to
wish More Power but as the saying goes, great power comes great responsibility
and based on experience IntelliCare was just not ready for that. Thank you
nonetheless and the Good Lord always repays us with what is JUST so God bless.
[i]
Pre-Existing Condition (PEC) –is a disability which is diagnosed before
enrolment or during the first year of member’s cover; that which presented
signs and symptoms of which the member was aware of; and illnesses whose
pathogenesis had started prior to enrolment
or during the first year of cover even if the member was not aware thereof
(Refer to your HR/Benefits
Administrator for your corresponding PEC coverage) –IntelliCare Guidebook,
Printed 2008, Version 1.0 Page 2
