Inspite of the hardships that i’ve been through lately, i still manage to stand up and yet still recovering.
Earlier this month, it was an unexpected case where my younger sister was admitted to the hospital due to Cerebral Palsy disorder which trigger her with seizures for few days.
Currently, our employer is engaged with this Health Insurance company called Kainos Health Management Inc. The said Insurance company is our HMO provider which provide us with full medical benefits and has served us for more than a year. I think we started to engage with themselves since 2008 up to the present.
I knew the fact that despite of their assistance that they provide, there is also an exclusion of illness/diseases that they don’t cover. So first thing i did i contacted the insurance provider and ask what do i need to do with the case of my sister?
Below stated the things i have experienced from them:
I have not been able to read our company’s agreement with Kainos. Though there is one thing i am certain of discomfort about emergency cases which is totally opposite to what Kainos stated below:
3. For confinement with carried order, please call KAINOS Care Hotline to facilitate confinement and so that a representative can assist in your confinement.
In my case, my sister who has a congenital disease, Cerebral Palsy occured 1st of August 2010 with on and off seizures in 4 consecutive days. As a result, she becomes weak and restless, she no longer eats food unless someone has to guide her through. My mom is now feeding her with milk to keep her stomach warm to ease from hunger by spooning the milk from the glass and put it on her mouth. And so, i told them that we really have to send her to hospital for further treatment and proper care.
I called Kainos 24/7 hotline 255-6298 for further instructions, but to my surprise, they can only send her to emergency if she undergo diagnosis from their clinic. I told them that we can’t take any further delay. My sister is already pale and her eyes, lips, hands and toes turn to violet in color which makes us so much worried about her condition. Their staff told me that its their standard procedure and there is nothing we can do but to follow.
Only to find that on their latest memorandum, restricting direct emergency access without further consultation from their clinic. (they are now clinic based).
So, i told my father to have her sent to the clinic to be diagnose. So that we will be given a recommendation before sending to emergeny at Chung Hua Hospital. We went there around 6 pm and was able to catch up an outgoing doctor to have my sister check-up. The doctor was kind of hesitant to diagnose her (think its not his specialty), he was then given us just a note to send her to emergency and we were not given an LOA as we expect.
Afterwhich, we are referred to their Benefits Officer and discussed the company’s agreement with Kainos regardarding to what they only cover. It turned out that we have to decide if we go for emergency. The doctor’s first impression was seizure due to her condition having Cerebral Palsy. The officer told us regarding with the coverage, Seizures is excluded from the benefits and that they still have to wait until the final diagnosis from a doctor in the hospital. Thus, we have to pay for the initial deposit for admission which costs 10K for regular private room (thats the only available the time we were in the admission office to arrange the admission of my sister). With no choice and for the sake of my sister, we paid 10,000 pesos for deposit.
Prior to the statement from Kainos on their memorandum sent June 10, 2010, there was no representative showed up and assisted us during the admission.
I spoke to someone name Rica, and passed on to their Heath officer then back to their hotline reps. Which drives me crazy as we are going round in circles.
There is one fact i have learned about Kainos that this company according to admission representative from CHH that Kainos is suspended from Chung Hua Hospital? Yet, Kainos recommended us to CHH.
Members does not deserve this kind of service. I mean we are paying them on time, they should suppose to treat us fair and equal. Despite of the dilemma we are experiencing, they should suppose to be doing these process. It’s their job and we have the right to demand what we need. But what have we got? we are screwed up.
I don’t think i should put on trust to them anymore. Im done with this and i will never let this happen again ever. At first, i thought this Insurance we have is worthy to pay as they give quality service. Well it was just at first but along the way, its like your driving down to hell.