MANILA, Philippines — The Insurance Commission (IC) has placed health maintenance organization (HMO) provider Carehealth Plus Systems International Inc. under conservatorship amid the company’s inability to address complaints from policyholders.
In a letter, IC commissioner Reynaldo Regalado informed Carehealth that it is being placed under conservatorship, a status that will allow the regulator to be involved in the management until the viability of the HMO is restored.
This developed as the IC said Carehealth is unable to address complaints from policyholders regarding the servicing of their health insurance claims.
“The additional complaints against Carehealth even reveal that the HMO has not improved its services toward its members nor has it paid its obligations with accredited healthcare providers,” Regalado said.
The STAR took a quick look at social media complaints on Carehealth and most concerns were on the unacceptance of the HMO in partner clinics, laboratories and hospitals.
Policyholders also raised the lack of response from Carehealth itself including its agents across various platforms, as well as the long process of reimbursement which is taking more than two months for some.
In October 2023, the IC issued a cease and desist order (CDO) against Carehealth to stop the HMO from selling any more health insurance to the public.
However, the IC directed Carehealth to continue servicing the health insurance claims of its existing policyholders, but the HMO did not comply.
As a response, Carehealth appealed that the CDO be lifted, but the IC denied such motion. The regulator, likewise, rejected Carehealth’s application for the renewal of its license amid numerous complaints from customers.
Under the law, the IC may put an HMO under conservatorship if it finds that the company is in a state of continuing inability or unwillingness to comply with its obligations to policyholders.
Data from IC showed that Carehealth recorded a net income of P4.25 million in 2021, while its health care benefits and claims reached P95.37 million.
This was the last data available on IC as the HMO provider did not submit any financial statement in 2022 and 2023.
Carehealth secured its license from the IC and the Securities and Exchange Commission in 2015.