No medical insurance

After writing about my experience with angiograms, double angioplasty and a repeat of all the above this week, it only makes sense to share my experience about medical insurance and the fact that I won’t have any insurance to pay for my procedure this weekend. On one hand, even if I did have medical insurance; it would be useless for a reason. On the other hand, I did make a conscious decision not to get medical insurance. Here’s why:

Before 2013, my wife Karen and I along with our daughter Hannah, were all covered by a medical insurance provided by a Swiss-Hong Kong firm. If I remember correctly we were paying approximately P250,000 a year. It also provided that we had to pay $5,000 as our participation fee in any medical expense. Yes, it was stiff but since we had a child and were travelling abroad regularly, the potential cost of hospitalization abroad was enough to convince us to part with hard earned money just to be on the safe side. That coverage was from 2000 to 2013 or more than ten years and a total of P2,500,000. In all those years we had no claims or expense because most of our hospitalizations were under $5,000 or P250,000.

Then I landed in the hospital for an angiogram and double angioplasty in 2013. I chose to do it at the Philippine Heart Center because the doctors there are probably the most experienced in the country. In addition, their prices were often only 50 to 60 percent of the prices charged by the top three private hospitals in Metro Manila. 

In spite of the medical insurance, I had to advance the payment of approximately P650,000 plus. As provided for in our insurance coverage, I had to pay around P250,000 as my share, which left P400,000 as collectible from the insurance company. Remember, by going to the Heart Center, I actually saved the insurance company a lot of money. I thought that when the company saw that I went to a public hospital, they would only be too happy to reimburse me.

Wrong! They shot down my request faster than a speeding bullet and stated that my condition was a “pre-existing condition” and therefore was not covered. The thing is I never knew of my blockages and they were a recent discovery. I immediately sought advise from doctors and friends in the insurance industry and that was how I found out that many insurance firms and providers “automatically” issue rejection slips on the first request, almost like a “bluff” to find out how determined a claimant is to collect. One doctor told me to file another claim but this time to threaten the company with legal and media action. That produced results although it took four months to get our reimbursement. It’s just so sad that people have to use veiled threats, or legal action to collect on legitimate claims. A few months later the insurance agent called to renew our coverage, and we flatly told him thanks but no thanks.

We figured that if we simply saved all the money we paid for coverage and added the 250,000 initial participation expense we would have saved P2,750,000. Deduct the 650,000 we spent and we would have had P2,100,000 left in the bank. If I spend the same amount as I did in 2013, we would still have P1,450,000  left. Instead we have nothing except a great big disappointment and a lesson about medical insurance. On top of all that, had we continued with our coverage, my second round of angiogram and angioplasty would not be covered because now, the procedures fall under a “pre-existing condition.” I realized there and then that the insurance company is more protected and secured against claims than the biggest casinos in the world. They get their money way ahead and then they get more if you’re crazy enough to come back to them.

There’s more. My mother used to pay a hefty sum to a local insurance broker and she paid a stiff price because she was past 70 by then. Those payments sucked up her life savings until one day a kind soul from the industry told her not to carry on with her coverage. In the end she paid ten times more for insurance than she ever got billed for her longest and last hospitalization.

My only regret from all this is that I did not have the self- discipline to put aside the “insurance payments” in a bank account. If I did beginning 2013 to 2018 I would have saved P1,250,000  and only half of that would go to my operation. If we did all that since 2004 we would have saved 3,750,000 and still have lots aside. Fortunately, God provides and we can cover it. But God willing, we will now make sure we have mandatory savings for medical expenses. If you are an employee and your company provides medical coverage then take it. If you are traveling abroad, it would be wise to get medical insurance. But if you are considering long term insurance payments make sure you ask all the questions, do the numbers, get an accountant, lawyer and physician to give their advise on the package you are considering because it may all be too good to be true.

I share this with our readers today who might be similar in status. My wife and I are not full time employees, I fall under the “talent” and contributor category so I have to pay for all my SSS, PhilHealth, and pay out of pocket for medical necessities. We thought that being insured was a good idea until we became victims just like many people especially those in their senior years who have been excluded as “old” or “high risk” or potentially terminal to cover.

As it turns out there is profound wisdom in the saying: Save it for a rainy day!

* * *

E-mail: [email protected]