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Healthcard Reimbursement Issues

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1 Healthcard Reimbursement Issues on Tue Nov 12, 2013 7:00 pm


Arresto Menor

I need advice regarding my dispute with our health care provider. Details are as follows:

I was diagnosed last August of this year with SLE (Lupus) and the test was done and covered by a clinic accredited by our healthcare provider. Then my family med doctor referred me to see a rheumatologist. Since I was pregnant at that time, I had to find an accredited rheumatologist in FEU (where I gave birth). After seeing an accredited rheumatologist, she referred me to redo the tests as she was not confident with the test performed by the clinic. For best results, she referred me to NKTI. I confirmed with our healtcare provider that the tests are covered however did not inform me that I have to secure an LOA from an accreditor in NKTI. When I went to NKTI, the said accreditor had left already. I did not want to waste my time anymore since my life was at stake, I was on my 8th (going 9th) month already and we had to know if I really have lupus. So i contacted our healthcare provider and confirmed that it will be reimbursed. So since I am already at NKTI, had extra money at that time, eager to get the tests done, I went ahead with the procedure. Ayaw q na pabalik balik kasi dahil buntis nga aq. Then after a couple of weeks, I submitted a request for reimbursement - it amounted to 6,990. Recently, when I followed up the status of my request, I found out that it was declined because they said that the requesting Doctor is not accredited. I did a second follow up questioning their decision. Then this was the only time they clarified to me that the requesting doctor should be accredited of the said hospital. Please note that the requesting doctor was from FEU and is fully accredited (i am still having my regular checkups done with the same doctor using my healthcard) and the laboratory tests were only done in NKTI and I was never admitted in that hospital too.

My questions now are:
What legal actions can i take regarding this matter?
Can i even sue the healthcare provider?
If yes, on what grounds?

Any assistance will be greatly appreciated.

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