Last Monday, January 26, 2009, I noticed my baby who is still 2 months old started pooping bloody mucoid so I decided to rush her to the nearest hospital (North Gen. Hosp.) for emergency check-up. Her attending physician's first diagnosis was ameobiasis. Later part of that day, her doctors found a sausage like mass in her lower left abdomen. She was then referred to a pediatric surgeon to examine her condition. I got too scared when I heard of the word "surgeon" for it means operation is needed. When the pediatric surgeon came to see my little princess, I got scared even more for the pedia won't go in to help her instead he referred her to another pediatric surgeon who is affliated in Cebu Doctor's Hospital. We were then transferred through an ambulance to Cebu Doc. for further examination & treatment. On our way to Cebu Doc, my baby started throwing up all the milk that I fed her that day which made me even more scared and pity my baby for I can't do anything to relieve her from discomfort.

During her admission in North General Hospital, her Maxicare card was swiped where I signed a Letter of Entitlement. When we were transferred to Cebu Doctors Hospital, same thing goes, her card was swiped again for her accommodation and initial treatment just like the normal process of admitting an insured member for Maxicare. Although I have only P500 left in my wallet, am quite relieve for she is my dependent and I know that Maxicare's going to take care of her hospitalization.

The following morning, my baby's pediatrician and pediatric surgeon examined her and decided for immediate operation. I got frightened for my baby is too fragile, imagine she's just 2 months old & will be facing a major operation?! I am afraid for she might not be able to make it but her doctors said that its the only way to save her so I just signed the waiver for them to perform a straight-cut surgical operation on her upper abdomen. Her schedule in the operating room was at 12 noon on Tuesday, January 27, 2009. An hour before that, I am surprised to see a Maxicare Roving Personnel, in the person of Ivan, came in to our room in the said hospital informing us (me, the father of my baby, my mother, my sister and her friend) that she has no insurance coverage for Maxicare. He mentioned that my baby is an additional dependent and has a congenital condition therefore she has to wait for 12 months for her to be covered with the plan. I was so overwhelmed with the information I received from him. I felt so down for I don't know where to get money for the down payment before the operation can be performed. I felt so helpless seeing my baby dying due to excessive loss of blood excreted together with her stool. I am anguished for what had happened to us that day. I tried to calm down to think of better things just to save the baby. Good thing, our doctors advised us to seek assistance with our HR so immediately reported the issue to Janet Borgonia of HR Cebu. She said that she escalated my issue to her boss, Maricel Amores. I waited for a response from the HR personnel while my baby's operation was put on hold because Maxicare will not cover the said surgical operation. Janet got back to me like about an hour after I called the office but she has no good news. She informed me that my baby can't be covered because she is a newly enrolled dependent with a congenital condition.

I can't describe in writing the feeling I felt that day. I wanted to save my baby as soon as possible but her account is put on hold due to the issue with Maxicare. I was alarmed for anything can happen to my baby who is already very pale due to excessive blood loss and worse is, the hospital didn't start the blood transfusion for we have no down payment made yet in the hospital's blood bank. I really can't imagine why on earth did it happened to me when I comply with all the requirements asked by HR during the enrolment process. I enrolled my baby on time to our health care provider not only to ensure her safety but to have a cashless consultation and hospitalization but what happened was ironic and very tragic specially seeing my baby suffered because of someone else's negligence! Good thing the billing department gave a clearance for the operation to start that day when I begged them to just save my baby first and I'll just settle the bills later after the operation.

At 6:00 PM that same day, I kissed my baby good luck at the front door of the operating room with all hopes and prayers for her successful operation. In the chapel, I cried a river while continuously praying for my baby's safety. In God's mercy, my baby was saved after 3 hours in the operating room. She was brought to the recovery room for another 2 hours before she was brought back to our private room.

The following morning, the hospital started billing me for almost P50,000.00, have nothing on my wallet so what I did is I contacted my friends and borrowed money from them just to make a deposit. Everything that happened to me the other day still didn't sink in. I tried to ask for help from our HR but they are only good at lip service and they're not helping anyway not even a single investigation on my case.

Knowing that HR didn't support me all the way and that Maxicare would only look for (dumb) loopholes in order to escape from their responsibility, I started fighting for my baby's benefit that has been eluded from her. I started gathering all the documents needed from the hospital to Maxicare including their website and other pertinent documents available in the office. I reviewed the pamphlet for eTelecare Global Solutions' Maxicare Coverage Plan for Aug. 1, 2008 to July 31, 2009 (available in the clinic). I focused on the section Additional Concessions and to quote: "Pre-existing illness conditions - all newly enrolled dependents of a newly enrolled principal members, pre-existing conditions are not covered on the 1st year of coverage, subject to 12 month waiting period." Now, according to pediatric surgeon, Dr. Rene Rafols, and Dr. Alice Militante, my baby's case is not congenital or pre-existing rather its an acquired condition.

I tried explaining this information to our HR, broker & Maxicare hoping that they would cover for the hospitalization but another reason that drove me very very mad on Maxicare. That certain Ivan from Roving Team still didn't approve the hospitalization coverage for according to him, my baby's case is dreaded and that it has no coverage not until 1 year! At the back of my head, I know that my baby's case is not a dreaded one and i can support it with pertinent documents. In fact she is perfectly fine now. No medicine maintenance and no follow-up operation needed. ITS PRETTY OBVIOUS THAT MAXICARE IS TRYING TO OUTSMART ME, MAKING ME FEEL DUMB THAT I DON'T KNOW THE TERMS OF SERVICE AND INSURANCE POLICY JUST TO ESCAPE FROM PAYING THE HOSPITAL BILL AMOUNTING TO ALMOST P120,000.00 PLUS.

At present, my baby is already discharged from the hospital but am sad for the only lot title we had was used as a collateral for the hospital's assurance that we will pay for the remaining balance on our account. After all, am very blessed for my baby has recovered faster than her doctors have expected. I know and am certain that Maxicare is liable for all these anguish I had and for denying my child's benefit. Am going to fight all the way just to give justice for my baby.

I wish you all would share with me in this struggle by offering a petition prayer for the success of all my endeavors in seeking justice for my baby. And am looking forward to having a new health care provider in Aug. 1, 2009 . NOT MAXICARE FOR I DON'T WANT THAT SOMEDAY THIS EXPERIENCE MIGHT HAPPEN TO YOU OR YOUR FAMILY!

From: ~AngeL~

Angelie E. Lopez

Please pass.. Copy and paste it to your blog...

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