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Expat Health Care (US Citizen) - Pre Existing Conditions


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TheWhiteKnight

So ckfm mentioned that pre-existing conditions as a main reason a lot of us are stuck with gov health care plans. This got me thinking about how to approach this best. I'm only 36 but I was once admitted to the hospital in the US with some killer heartburn, they gave me some anti-acid which was like the normal stuff you buy but it also had a numbing agent. It made me feel like instantly better, then they prescribed omeprazole and some other drug that coats the tummy and I was fine. They mentioned it could be GERD and to go to my regular PCP for a possible endoscopy (with the camera). So I mention this because apparently somewhere out there, there is record of this, and I guess because it was even mentioned it could be a per-exisiting condition and need to be disclosed when trying to sign up to any new insurance. BTW - I also now take omeprazole often to keep heart burn in check, who knows maybe I really do have GERD so that's why I'm even more scared of having it excluded (and all related conditions) from coverage when I'm only 36 and could end up paying in to this nonsense for 40-50+ years.

Fast forward to a couple years now, I've had A++ Expat Insurance and I was honest them on that app about certain questions and they went ahead and excluded ADHD (I don't know, I don't really have it and don't care to be treated for it) and GERD related stuff. So now I'm on the record of an insurance application :( might have been stupid of me to do this.

I want to sign up for the Pacific Cross - Blue Royale Dollar Plans - but I'm wondering just how honest I should be about this - is there already some huge insurance information sharing going on between most of these companies, will they figure it out in the even of a claim?

Should I actually sign up for Philhealth even with the new fees as they might actually still help me with GERD some day?

Any other options?

You guys with universal healthcare are lucky.

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Well, luckily I had another hospital option, and was quite pleased with the cheaper hospital. I've been in both Silliman and Holy Child now, and the nursing staff at Holy Child is far superior to Sill

I just looked at the cards and what they offer. To me its a pretty sleazy way of  describing what they offer. A Dengue card- with 10,000 coverage for accidental dismemberment ?  Do lots of people

My solution is to carry a credit card plus the details of my international health insurance. The latter is reimbursement only, of course.

TheWhiteKnight

Also all these plans are touting how you don't need to see a doctor to get coverage, I actually WANT to be evaluated by their doctor so I know that they are covering whatever they say they are covering for sure.

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I do not even think Phill Health has a doctor to check you if you wanted them too

It just pays a percentage of your Hospital Bill they do not worry about existing health issues you may have but if you are hospitalized released then before 6 months passes are remitted for same illness they will not cover it but after 6 months no problem. I had this happen with a recurring case of pneumonia

I think the 17,000 is fair price for the coverage 

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aussiekangaroo
52 minutes ago, cogon88 said:

I do not even think Phill Health has a doctor to check you if you wanted them too

It just pays a percentage of your Hospital Bill they do not worry about existing health issues you may have but if you are hospitalized released then before 6 months passes are remitted for same illness they will not cover it but after 6 months no problem. I had this happen with a recurring case of pneumonia

I think the 17,000 is fair price for the coverage 

What is 17,000?

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aussiekangaroo

Phil health is 300 a month and Pacific Cross for 32 year old is around US $866.75 with treatment area limitation.

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TheWhiteKnight
33 minutes ago, aussiekangaroo said:

Phil health is 300 a month and Pacific Cross for 32 year old is around US $866.75 with treatment area limitation.

PH starting July 1, will be P17K per year for ALL foreigners.

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aussiekangaroo
1 hour ago, TheWhiteKnight said:

PH starting July 1, will be P17K per year for ALL foreigners.

In that case it's a rip off compared to spending a bit more for Pacific Cross Blue Royle A plan.

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17,000 piso is 338.00 USD per year / pays around 25% of your hospital bill 

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The Cold War Kid
On 2/22/2017 at 5:24 AM, cogon88 said:

17,000 piso is 338.00 USD per year / pays around 25% of your hospital bill 

r u certain of this?  others have said it paid much more?

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Headshot
6 hours ago, The Cold War Kid said:

r u certain of this?  others have said it paid much more?

I don't know where you got your information, but it was wrong. 25% is about the most I've seen it pay. Philhealth is just a medical supplement. It is NOT intended to pay your whole medical bill. It is amazing that it pays as well as it does as cheap as it is for citizens. Senior citizens get it free, but it still only pays a portion.

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angbumabasa
8 minutes ago, Headshot said:

I don't know where you got your information, but it was wrong. 25% is about the most I've seen it pay. Philhealth is just a medical supplement. It is NOT intended to pay your whole medical bill. It is amazing that it pays as well as it does as cheap as it is for citizens. Senior citizens get it free, but it still only pays a portion.

Family here got about 50%. Varies slightly per individual situation. Children's Hospital in Maasin City. We (I) pay the rest.

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Jawny

https://www.philhealth.gov.ph/benefits/

Philhealth has a fair amount of information online explaining their case rates.  Some are paid in full.  If a LinC member has some particular needs, doing some research on their website will reveal what is to be expected.  I included just one page as an example.

i had the impression there is no denial of benefits because of pre existing conditions.  Even now the country is trying to get more people registered and some of these for free such as senior citizens. This population would almost certainly have pre existing conditions. Poverty has a way of ensuring that.

Some of the benefits are so good that there was even a significant amount of corruption related to this a year or so ago.  Some eye surgeries were being done on partients with questionable needs for the surgeries.  The clinics involved were getting rich doing these cost free (to the patient) surgeries.

i recall that among the linC membership, there are a wide range of tales of getting fully reimbursed and others getting little.  Same can be said for some of the member experiences with private insurance.

The possibility of patent records being shared between insurers from other countries seems slim.  

Edited by Jawny
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Headshot
1 hour ago, angbumabasa said:

Family here got about 50%. Varies slightly per individual situation. Children's Hospital in Maasin City. We (I) pay the rest.

You are correct that it depends on the situation. I am surprised that you have seen a payment up to 50% of a bill. However, in my experience (and I have had to deal with this several times with family members), I have not seen the Philhealth portion go over about 25% of the total bill. Everybody's mileage may vary, but nobody should count on Philhealth as an actual insurance that will cover a medical bill. It just isn't going to happen. They come up with partial payment. You are expected to come up with the rest (which is usually the lion's share of the bill).

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Salty Dog
2 hours ago, Headshot said:

I don't know where you got your information, but it was wrong. 25% is about the most I've seen it pay. Philhealth is just a medical supplement. It is NOT intended to pay your whole medical bill. It is amazing that it pays as well as it does as cheap as it is for citizens. Senior citizens get it free, but it still only pays a portion.

It paid nearly P30,000 on my wife's two visits to the hospital. One was to have her appendix removed and the other was for a day surgery.

Philhealth’s coverage for appendectomy is currently:

24,000 pesos —  Total Coverage
14,400 pesos — for hospital expenses
9,600 pesos — for professional fees (PF)

She had it about 5 years ago so it was less then. She was in the hospital for 5-6 days and I think the total was around P100,000. She had a private room at Silliman Medical Center in Dumaguete. The room though was only P2,500 a day. The biggest expense was the surgery. The prick surgeon made me pay the full amount in cash P34,000 and then took the PhilHealth payment on top of that. There was also the anesthesiologist which was another P10,000, but he was paid through the hospital bill. Finally there was her primary care doctor who also got her cut in cash of around P10,000.

I was surprised when she had the day surgery that cost about P9,000 and PhilHealth paid P6,000 of it.

 

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The Cold War Kid
8 hours ago, Headshot said:

I don't know where you got your information, but it was wrong. 25% is about the most I've seen it pay. Philhealth is just a medical supplement. It is NOT intended to pay your whole medical bill. It is amazing that it pays as well as it does as cheap as it is for citizens. Senior citizens get it free, but it still only pays a portion.

Well, headshot, I hope u don't think I am making it up?   ?

Suddenly I am banned from reading the original, now closed thread?  Else I would respond with a link to that post.

Anyway, someone said it was still a good deal in that thread.  And so I asked.

All of which leaves me right where I was, which is nowhere.  My medicare supplement will pay 80% but I have to pay up front, then they will reimburse.  I have a hard limit of $200 a day on my debit card, to avoid being ripped off.... I could get a credit card but, unlike most, I read the application - roflmao!  No way in he77 I sign anything like that!

I'm amazingly healthy, considering how ancient I am :)  I take good pills - what can I say?  PQQ and CO-Q10 and Piracetam...  Still, an accident might happen?

Apparently, the community has yet to find an answer to this?  And so it is in the US, as well, if you're not 65+ years old.  Even then... it can be dicy.

I take it a joe (that's what they call us - lol) who is a senior citizen does not get it for free?

I think I know the PH people... at least a little.  I admire them.  I am going there because of them - well, that and my money actually buys something there. 

I read how they will let you die if you can't pay up front.  I don't believe that - not for 1 second. Maybe you can't get a triple bypass (or whatever) but when I was in Anda (on bohol) I got a little sick and the place refused to even take my money.  THAT about gave me a heart attack - right there - a DOCTOR, refusing money?  I had to make a donation.  So I did - 500 pesos and they were grateful!

There are some really mean people in here.  So much so that now I am leery of making physical contact with the "expat community." 

I don't see why PH even puts up with "us."  In Dumaguete the situation is really bad for "us" because of a few assholes - who are not even americans at all.  But everybody is laying for you - even the laundry place!

It's horrible to think what we teach the gentle, beautiful people of PH is what a redneck is...  So very sad.

Well, this time *I CAN* do something about it, and *I WILL.*  I will let my light shine on them - all of them.  I will show them that not all joes are nasty people.  Who will help me?

Edited by The Cold War Kid
before my lobotomy, I could type...
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