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Need help/advise on healthcare insurance issues

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iamfritzleo


Arresto Menor
Hi Atty.:

Need lang po ng advise kung ano po ba magandang hakbang na gagawin. Nabiktima po ako ng hit and run habang sakay ng motor at papuntang opisina. Galos lang po sa braso at kamay yung natamo ko. Nung dumating po kami sa ospital in-advise po ng doktor na mgpa admit ako. Pero bago po iyon eh venirify po muna ng ospital sa healthcare insurance provider (Intellicare) ko kung covered daw po ba pag maaadmit ako. Sabi po nung nagverify sa intellicare eh covered daw po lahat at pumayag naman po ako na magpa admit sa paniniwalang iko cover nila yung hospitalization ko. Nung bumisita na po yung liaison officer ng intellicare sabi eh hindi po nila covered pag vehicular accident lalo't me 3rd party daw po na involved. Para daw po icover nila yung hospitalization ko eh kelangan ko daw po mgsubmit ng ilang documents: 1. police report; 2. incident report; 3. driver's license at; 4. ORCR nung motor. At pag kulang daw po yung nasubmit ko eh hindi nila iko cover at subject pa daw po for approval kung covered daw po o hindi.

Ni refused ko po yung mga requirements nila. Unang una po, mahihirapan po ako kumuha nung driver's license nung driver nung motor at ng ORCR (pasahero lang po ako nung motor). At pangalawa hindi po ako nakapagfile ng police report nung mangyari yung aksidente kasi na admit na po ako kaagad.

Yung point ko po na sana in-inform ako nung intellicare na hindi nila covered pag vehicular accidents para sana hindi na po ako pumayag magpa admit. Eh iyong nangyari po eh hindi man lang ako na inform beforehand nung tamang policy nila pag vehicular accident. At pwede naman po na hindi ako magpa admit dahil galos lang sa braso at kamay yung natamo ko. Wala po akong perang pambayad at kung alam ko po na ganun yung mangyayari eh di sana po hindi ako pumayag na magpa admit dahil hindi naman po grabe yung sugat ko.

Ano po yung pinakamagandang hakbang na dapat kong gawin? Pwede lang po ba iyon na sabihin nilang covered pero hindi nila na-idisclose na hindi pala covered unless nakumpleto ko yung requirements nila? Ilang beses na po akong tumawag sa opisina nila pero parang pinagpapasa pasahan lang po nila yung reklamo ko.

Thank you in advance and more power.



Last edited by iamfritzleo on Sun Oct 26, 2014 1:19 am; edited 1 time in total (Reason for editing : corrections)

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