Wednesday, June 20, 2007

Asian Hospital - 18-20 June

In order to hopefully save others any frustrations of the nature of which we experienced, I am documenting the problems we experienced while seeking our treatments at Asian Hospital. Asian Hospital seemed to us every bit as good, medically, as we had hoped it would be; however, frustrations regarding insurance coverage, that seemed to us to be unnecessary, made our experience less comfortable and, frankly, resulted in a waste of time that should have been used to seek other kinds of care we had hoped to receive while there. We are still in Las Pinas, so comments on our efforts to get out of here are of note.

On 21 June, I had quite an experience trying to get tickets for a flight to Butuan. Like driving in Manila's famed traffic, trying to get a ticket online was a second to second, hit or miss exerience: a ticket for 1650 Pesos disappeared within 15-20 minutes, at which point no more tickets were available that day. A few minutes later, tickets for 3,000+ Pesos were available, then they were not. A few minutes later, a some tickets for over 5,000 Pesos were available on the same flight!

Note, 22 June: I was able to purchase tickets over the phone. The experience was unsatisfying, due to a combination of factors: dysfunction of Internet connections, changes of availability of seats and prices of tickets on the Cebu Pacific Air web site, a Cebu Pacific call center setup that does not deal adequately with calls made after business hours (resulting in long waiting periods on the phone when calls are not actually being answered), variability of cell phone connection function, busy phones, and my own habits. We unnecessarily spent at least 400 Pesos on cell phone charges, and we lost a ticket early in the day to the above mentioned problems. In the end, we were able to purchase tickets a day later and at a higher price, leading us to stay a day longer in Las Pinas than we had hoped. The matters mentioned above are beyond our control.

The timing of our trip to Butuan had depended upon the completion of our treatment at Asian Hospital. Had the business aspect of our visits to Asian Hospital gone more smoothly, we might have saved a day, saved at least US$100.00 of out of pocket expenses (that will be repaid by the insurance company later, but leads to less pocket money for the trip and loss of a good deal of time at Asian Hospital dealing with insurance issues that should have been straightforward. This part of my report deals, then with frustrations in the business side of the visit. Medical aspects, happily went quite well, and will be reported later.

The bottom line on the insurance and business aspects of our trip was dealing with the different pictures we received from our insurance company, AETNA Global, and the International Health Services (IHS (, also identified variously as IMS, International Medical Services by the administrative assistance of that office, Ms. Therese Loria). AETNA informed us over the 1-800-# that AETNA would direct pay any work at Asian Hospital costing over 500.00, and that AETNA has a department devoted to direct payment. (Direct payment means we pay only 20% of the billing on site, while by previous arrangement, AETNA would directly pay the hospital the remaining 80% of the charge. However, the Asian Hospital International Medical Services office informed us when we were already on site that we are responsible for "self pay" of all but inpatient services. Outpatient services, we were told, were self pay, to be paid out of our pockets, pending later reimbursement by the Insurance provider.

This disjunction between the statements by AETNA and the IMS/IHS caused us considerable grief during our first two days at Asian Hospital, Friday, 15 June and Monday, 18 June. Over that weekend, I contacted AETNA's 1-800-# to request clarification. The parties answering the phone for AETNA were surprised at what I had been told by Therese Loria of Asian Hospital's IMS/IHS. AETNA related, in a security sealed email, with cc copies to three persons at, the terms of the arrangement between AETNA and Asian Hospital. I intend to call these matters to the attention of the Asian Hospital administration, including these three persons. In the end, I had to physically hand a cell phone over to Therese Loria, with AETNA staff of the other end of the line, in the process of attempting to come to terms with the different policy statements made by the hospital and the insurance company. Finally, we were able to come to the terms we had hoped for.

The insistence of an AH staff member on 15 June that only In-patient care was "covered" by AETNA, and would be reimbursed by AETNA back home on Saipan, would have meant we would have had to pay more than US$1,000.00 more out of pocket to cover the insurance company's 80% of our bill. On the 15th, all of our consultations were paid as "self pay": all of our referrals to physicians for consultation were written by Therese Loria, and prominently marked as "Self Pay" in large letters, highlighted in orange. A cover letter was generated by Ms. Loria for each consultation, in which a paragraph clearly explained to the physician the importance of collecting full payment from the patient.

I will not be able to complete this report at this time, due partly to a raucous atmosphere in this Internet Cafe, where (it being friday night) a large number of school age students are playing internet based games and calling back and forth across the room. I am in the VIP area, explained to me as the quiet room: even this room has been invaded. I'll make a list/outline in anticipation of completing this report at a later time.

  • Terms explained by Therese Loria, the only person present in the IMS room. Recipient of email for
  • CC recipients for email from AETNA beside myself and, 3
  • I originally asked to be scheduled for in-patient lithotripsy, which was explained by Dr. Salileng as an outpatient procedure, so that my care would be covered under direct pay arrangements by AETNA for their 80%, as explained by TL.
  • Fe asked for her MRI to be in-patient also. While Dr. Joy Fontanilla said she thought it could, in the end, it would not be possible for her to sign for it. TL tried to ask her.
  • AETNA explained it was not each individual billing item that had to reach 500.00, but the expensed related to the issue, at the same time. (I assumed that to mean not at different times visiting the same hospital).
  • In the end, it took a considerable amount of time, but our care for Lithotripsy (Alan) and MRI and Endocrinology work (Fe) were done as out-patient care, with direct pay from AETNA.
  • I met another friend outside the hospital on Monday, 18 June, who had been released after a lengthy in-patient treatment for a leg by pass. He has been treated several times at AH. When I mentioned "direct pay"/"self pay" and "inpatient"/"outpatient" to him, he offered, "I know a way around that". He said, have the Doctor admit you as an in-patient as soon as you see the physician.
  • AETNA made it clear to the hospital that I should not be treated as an in-patient unless it was considered medically adviseable to do so. It would mean, AETNA clarified, my out of pocket expenses would be higher!

On Monday, 18 June, I met a friend from Saipan at Asian Hospital who is a US Government Employee, covered by Blue Cross. I took him to Therese Loria's office after he had been summarily told by the billing office of AH that he would have to pay and be reimbursed back home. His reception by Therese Loria was telling: he was told in no uncertain terms, that all out-patient care for International Patients was to be paid out of pocket and reimbursed back home by an easy reimbursement process. My friend remarked that had been through this in the past, and it is not either easy. He was told the same way that I had that his insurance woujld "kick in" for In-patient care.

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