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HMO denied claims of gay patient with pneumonia, assumed that it was an HIV-related disease

For verification, they even ask the patient if a rapid test was done by the doctor.

  • Maxicare did not allow the coverage of a pneumonia patient because of the treatment given is suggestive to HIV-related
  • They felt discriminated because the patient is gay as they assumed that his disease is an HIV-relate
  • Maxicare will not approve any claims or reimbursement unless he is proven negative

A Twitter user named Moon Moon who had a friend confined at Makati Medical Hospital posted a tweet saying that health maintenance organization (HMO) Maxicare is homophobic simply because they denied the coverage of their payment based on assumptions that his friend’s sickness is HIV-related.

“HMOs (specifically Maxicare) are homophobic. My friend (male) is currenlty confined at Makati Med and was diagnosed with community acquired pneumonia. Maxicare denied coverage based on assumptions that it is HIV-related and treatments were done to the patient related to it.”

Based on the medical abstract/discharge summary that was issued and verified by the attending physician, there was not any HIV-related item indicated which made him conclude that the Maxicare decided based on assumptions.

For verification, they even ask the patient if a rapid test was done by the doctor. But for him, the primary basis that they should look into is the medical abstract of the patient where the procedure and medicine that was given to the patient was all documented, not look on the assumptions.

On their part, they felt discriminated against knowing that the patient who acquired pneumonia is gay and they assumed that he has HIV. Though he admits that there is a historical correlation to conclusion, it is important to look at the facts documented by the hospital.

The hospital bill went up to 480 thousand pesos and they were asking for reconsideration from the Maxicare to pay the 175 thousand pesos based on their policy.

Maxicare gave them an update, telling that it was not covered by their company’s health insurance policy which made them very inconsistent.

So they called Maxicare and asked if they could escalate it to the Insurance Commission and to their surprise, they were asked to hold off because they are still investigating it.

After the investigation, it was already verified that it was covered according to the Maxicare provision. However, the Maxicare resident doctor’s decision remained the same and when they asked why their request was denied, Maxicare said only the doctor knew the reason.

They even talk to the Maxicare corporate account manager to escalate their case. They decided to pay the full amount of their hospital bill for the patient to be discharged. Still, they hoped that Maxicare could give them a reimbursement afterwards.

They also tried looking for similar cases on social media and discovered that they were not the only one who had experienced discrimination.

Finally, Maxicare gave them feedback telling them only certain tests or coverage were allowed with their policy. In his friend’s case, the manner of treatment is very suggestive that it might be HIV-related. Maxi are would not approve any claims or reimbursements unless the patient is proven HIV negative.

Netizens also showed support by suggesting ways to help them. One netizen said that it is better to review the coverage of the health plan.

Written by Rhelyn Harder

An open-minded person who seeks to inspire readers through writing. She believes that having the freedom and courage to express oneself is an opportunity to influence others.

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