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FAQ 'S

This document contains answers to frequently asked questions about health insurance coverage and procedures. It addresses questions about what is covered for elective and emergency services, how to file claims, additional doctor fees, accommodation upgrades, benefit inquiries, PhilHealth filing, lost ID cards, ambulance transfers, and the need to present ID during availments.

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Edrian Boado
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
156 views

FAQ 'S

This document contains answers to frequently asked questions about health insurance coverage and procedures. It addresses questions about what is covered for elective and emergency services, how to file claims, additional doctor fees, accommodation upgrades, benefit inquiries, PhilHealth filing, lost ID cards, ambulance transfers, and the need to present ID during availments.

Uploaded by

Edrian Boado
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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FAQ’s

QUESTION #1: If I avail at a non-


accredited hospital for an elective
confinement or out-patient
consultation, can I reimburse?

No, members may only avail from


accredited doctors at accredited
hospitals and clinics.
QUESTION #2: What do you
mean by Confinement or
Hospitalization?
A person is said to be confined or
hospitalized if admitted in a hospital as a
registered bed patient for atleast twelve
(12) hours.
QUESTION #3: What do I have to do in
order to reimburse my bills for
availments in Non-Accredited Hospitals
during Emergency cases?
The member has to submit the following:
a. Duly accomplished Claim Reimbursement form (downloadable
from www.maxicare.com.ph or from HR/Clinic)
b. Original official receipts of all hospital bills, including the
statement of account and its charge slips
c. Clinical abstract of the case, if surgical intervention was
performed and its his histopathological report
d. Operative record of the case/treatment or admission/discharge
record
duly signed by attending physician
e. All pertinent documents to support confinement
Immediately complete the require Claim Reimbursement Form and
Documents stated above and submit the same to Maxicare within 30
QUESTION #4: Is it true that EENT,
Neurologist and Urologists issued a
memorandum to all
HMO’s stating that they will charge
extra professional fees?
Yes, and to avoid this, please coordinate with
our Customer Care Department before each
availment in order for them to make
arrangements with a doctor who does not
charge extra.
QUESTION #5: What if I want to stay in a
more expensive room and am willing to
pay for the accommodation, may I do
so?

Yes. However, keep in mind that staying in a


more expensive room also makes the other
services (i.e. medicines, professional fees
etc.) more expensive. The member will be
charged for the excess over the entitlement
provided in plan and he/she should pay
these charges upon discharge.
QUESTION #6: How do I know if a
certain diagnostic procedure requested
by accredited doctor is covered under
my program?

For inquiries, on your benefit coverage, you


can call our Call Center hotlines (02) 8589-
1900; (02) 8798-7777. Our Call Center
Specialists will ask for your medical details
to assess coverage of your availment based
on your Maxicare Program.
QUESTION #7: What happens if we fail
to file our Philhealth Benefit Claim
form upon discharge?

If the Member fails to file the Philhealth


Benefit Claim Form, he will have to pay for
the Philhealth cost equivalent upon
discharge.
QUESTION #8:What do I do if I lose
my Maxicare ID Card?
You have to fill the Maxicare Statement of Lost ID
Card and submit it to Maxicare together with Php
200.00 as payment for the lost ID Card. Your new
card will be issued within 7 working days from the
date the necessary documents were forwarded to
Maxicare. If you wish to avail while your card has
not arrived, call Customer Care Hotline first before
seeking consultation. In an emergency, instruct
companion to contact Maxicare.
QUESTION #9: Would Maxicare cover
the ambulance transfer from the
residence to a hospital and vice
versa?
Ambulance service is only applicable for
hospital to hospital transfer only subject to
the member’s coverage.
QUESTION #10: Is it really necessary to
provide an Identification Card (ID)
during availment?
Yes it is necessary to provide ID during
availment for coordinators/Customer Care to
validate the person availing is the one
entitled for the said benefits.

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