Unlike millions of Filipinos, I am blessed
with some kind of health protection via my HMO; HMO meaning “health maintenance
organization”. My HMO is part of the
employee benefits that Second Daughter (SD) enjoys from a company she has
served for almost eight years now.
I
get to really appreciate the HMO most when I or The Hubby meets a health
emergency. I once slid and broke my
wrist and the HMO covered all my hospital expenses such as the emergency room
services, x-rays, scans and subsequent medical consultations. SD likewise gets to benefit from the HMO
whenever she twists her ankle accidentally.
Note that she has the predisposition to do so every year or two. Thankfully, the HMO covers even the costs of
physical therapy.
The Hubby and I, however, much to SD’s
frustration, have never been inclined to use the HMO services even as aches and
pains manifest. Maybe because of our
senior years, we tend to be in denial and refuse to consult even while symptoms
develop. Unless, of course, the pain gets too
excruciating that there is no way out except the hospital! At any
rate, suffice it to say that we are so far contented to use our HMO card only
as needed. Often, of course, we pray
that we will never need it!
The Dental HMO, on the other hand, leaves
much to be desired if not totally turning out to be a rip-off.
For
several years, dental services were okay.
As long as the dentist consulted was accredited with the HMO you may
continually visit them for the necessary and covered services. Came time, however, when the HMO subdivided
dentists into several sub-groups; so much so that even if the dentist you want
to consult is accredited with the HMO you carry, you will still have to check
if this dentist is part of the sub-group that has been assigned to your
account. And, that was when we started
having problems with our dental needs!
For more than two years, we have been
playing Russian roulette trying to find satisfactory dental service from the
HMO’s accredited sub-group’s dentists.
Time after time, we have had such bad
experiences that I cannot seem to decide which of our annoying mishaps to start
relating.
For instance, there was this time when SD
and I went in for prophylaxis with an accredited dentist whose clinic was
located at the Robinson’s Galeria. After
the clinic’s receptionist had both of us sign the necessary documents, the
dentist started with SD. When SD stepped
out of the dentist’s cubicle, she whispered that the dentist was heavy
handed. I, nonetheless, decided to go
ahead since we were already there and we already signed the charge slips. When I was with the dentist, she asked me if
I had any heart condition and whether I had clearance from my doctor to undergo
dental prophylaxis. WTF! Whoever heard of asking a doctor for
clearance to have one’s teeth cleaned?
She simply refused. I got this
feeling she was in a hurry to get somewhere because she was constantly on her
cell phone while she was doing SD!
The Hubby, though, is the one who bore the
brunt of all the inefficiencies of these accredited dentists. His horror
stories are limitless – until the time when he decided he will never, ever
avail of the HMO dental services.
One time, Hubby and I went to a dental
clinic in Shang Mall to have (again!) prophylaxis. Two young, lady dentists, who seemed to have
come in after a shopping spree, attended to us.
They were just totally engrossed with their own chitchat while doing the
cleaning. Afterwards, the dentist who
attended him simply informed that she damaged one of his fillings. Oh, is that all! Being the pacifist he normally is, The Hubby
just took the information quietly. Until
the tooth started to ache!
The Hubby requested for me to find him an
accredited dentist nearby. I guess that
at this point, he was starting to develop an aversion to dentists who practice
inside malls. Luckily, or so I thought
at that time, I found an accredited one in a nearby subdivision. Off Hubby went to consult and have his tooth
filling repaired. What bothered him
afterwards was that the tooth still ached even after the so-called repair. Upon inspection, he found that the dentist
did not repair the tooth in question.
The man did the tooth right beside it!
Note that it was a perfectly okay tooth – no caries at all!
Right there and then, we decided to forego
the dental benefits of our HMO cards. SD and the rest of our brood question our
judgment and cannot seem to understand the rationale of having to pay for
services which we can avail of for free.
Fast forward to September 2012 - SD
requested to find an accredited dentist under the HMO. She wanted a tooth extracted because she
previously refused to shell out Sixteen Thousand Pesos to have root canal. According to the dentist she consulted before,
that tooth had four canals! Since it was
an inner tooth, she decided she will simply have it out and maybe pay for
retainers so that her teeth will not rotate.
At any rate, when I called to make an
appointment with a dental clinic in Megamall, I specifically said that this is
for extraction. The receptionist simply
instructed for the patient to get there at appointed time with her HMO
card. No other information was provided.
When we got to the dentist, we were told
that the HMO will only cover “simple” tooth extraction. And, before they extract, patient needs to
have an x-ray done. X-ray costs 400
pesos! And, if the extraction is
classified as a difficult one, then it will not be covered by the HMO and one
needs to shell out from Two Thousand to Five Thousand Pesos.
Because SD had free tooth x-ray done
before, she requested the clinic to verify with the HMO if this is indeed not
covered. While we were waiting for the
HMO’s response, the dentist offered SD to inspect the bothersome tooth. SD agreed.
Since SD already had her mouth open, the dentist then offered to conduct
oral prophylaxis. SD again agreed. Later, the receptionist confirmed that x-ray
is not covered by the HMO benefits.
I then advised SD to defer on the x-ray
because I was aware that the dentist Hubby and I consult charges even less than
the cost of x-ray for tooth extraction!
The Hubby made an appointment with this
dentist shortly so SD was scheduled to have the tooth extraction the following
week. The next morning, however, SD woke
up with a swollen cheek on the side of the troubled tooth. Could this be the result of the poking and
drilling during the cleaning process?
Who knows! At any rate, SD had to
rush to our dentist to consult.
Antibiotics were prescribed and SD hopes to be rid of the infuriating
tooth by next week.
Now, SD is in a foul mood towards the dental services of their HMO!
I
try to analyze the difference in the quality of service that we receive from
the medical and dental service providers of the HMO.
I realized that the medical service is normally
rendered in a hospital with medical practitioners accredited both by the
hospital and the HMO. Hospitals, being
complicated corporate structures, do have plenty to lose if the standards of
professionalism and medical ethics are not met. This alone should prevent any practitioner
from taking a short-cut in rendering services.
Worth mentioning, too, is the fact that doctors normally invest millions
to be allowed to practice in a particular hospital.
Dental clinics, on the other hand, are
normally owned and operated by one entity.
Usually, it is the owner’s name, a more senior dentist, that is at stake. Young, sometimes inexperienced dentists are
hired to render the services. These
dentists, unfortunately, flit from one clinic to another and are more
interested in acquiring more assignment than establishing a credible practice.
You see, while they are part of the dental clinic, they remain unknown and
unacknowledged. In fact, the next time
around that you go to the same clinic, you may not find them there anymore. So, if there should be subsequent problems,
the probability is that they will not be
there to respond to your complaints.
After all my griping, grumbling and
analyzing, I wonder – have they ever heard of dental malpractice?
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