Maxicare member guidelines on physician professional fees and screening tests

As of June 25, 2020

Maxicare and other members of the Philippine Association of Health Maintenance Organization Companies (PAHMOC) recognize that HMOs, our partner doctors, medical providers, and patients must work together to ensure the safety of all stakeholders during the COVID-19 pandemic. This includes sharing the burden of the additional cost of personal protective equipment (PPEs) and other precautions meant to prevent the spread of COVID-19. In light of this shared responsibility, consultation professional fees (PF) for all our affiliated medical professionals and doctors are temporarily increased to Php 600.

This temporary increase will apply for consultations performed from May 25 to August 25, 2020. The effectivity of this temporary increase may be extended or shortened as the COVID-19 pandemic evolves.

What benefits are covered by your Maxicare plan?

• Consultation
• Tests prescribed by a Maxicare-accredited physician

It has come to our attention that some hospitals, clinics, and doctors charge additional fees for services or items that are not covered by Maxicare, such as:

• Requiring members to undergo COVID-19 testing prior to consultation
• Charging the costs of PPE to patients

While it is possible that these extra measures adhere to their clinic or hospital’s safety protocols, these additional costs cannot be reimbursed by Maxicare, because they deviate from the testing protocol prescribed by the Department of Health (DOH) and not part of Maxicare’s coverage.

When can Maxicare reimburse the cost of COVID-19 testing?

• When the test is done at a non-affiliated provider and the test comes back positive
• When the patient tests positive, whether they are symptomatic or asymptomatic

What happens if the member decides to pay additional fees?
Maxicare will be unable to reimburse any charges beyond the coverable services if the conditions above are not met

What can you do as a member?
Suggested steps that Maxicare members can take if faced with such situation:

• Seek medical consultations through Maxicare’s 24/7 Teleconsult hotline at (02) 8582-1980 or visit their Primary Care Centers
• Call Maxicare’s Customer Hotline to report the incident:
  • (02) 8582-1900
  • (02) 7798-7777
• Search for other affiliated specialists who are following Maxicare’s guidelines
• Refuse to pay and Maxicare will refer you to another provider

Please take note of these reminders when visiting a doctor. We will continue to update you with the latest information and news regarding COVID-19.

Thank you and stay safe.