Tuesday, April 8, 2008
“Please help” the Medical Emergency
I received an email from a man whose fiance has a medical emergency in the family and she has asked for help. This kind of situation is always a difficult one to deal with. Many questions come to mind. Is there really a medical emergency, or am I being scammed? Am I the first resort or the last? Am I responsible for my fiance’s sister-in-law’s, brother’s, medical problem? How do I find out what is true? How can I be generous without being taken advantage of? And on and on.
First of all, let me explain a little bit about the system. There are two kinds of hospitals in the Philippines
Private hospitals usually require the patient to show their PhilHealth insurance card upon admission. Usually there is no down payment, but the expenses at admission are for medicine, IVs and oxygen. People need money for medicine, as private hospitals also just give the family a prescription and the family goes out to find it and buy it. Patients have to pay all fees (room, OR and professional fees) before they can be discharged, just like in a public hospital, so it is at the time of discharge that people really scramble to get money together.
If someone is asking you for money to help with a medical emergency, it is fair to ask for the name of the patient, the name of the hospital and the landline phone number of that hospital before committing any money. If this brings cries of, “You don’t trust me!” just say that you are sorry but this is the “American’ (British, Australian, Japanese, etc.) way of doing things. If she cannot give you that information, don’t send any money. I would also advise rethinking your romantic situation at this point. If she does give you this information, figure out the time difference and call the hospital during business hours. Remember that the people answering the hospital phones are not expecting to speak to a foreigner and may be flustered. Speak slowly and politely, using ‘Maam’ and ‘Sir’ to address people. Do not tell your story. Stick to business.
Ask for the billing desk and begin by asking if (name of patient) has been admitted, if yes, then explain that you are calling to check on the status of that patient’s bill. Say that you are a friend of the family and have been asked for help. Speak slowly and just stick to what you want to know: Has the patient been admitted there? How much has already been paid on the bill? What is the balance as of today? Does the patient have PhilHealth? Can I send money directly to the hospital to help with this bill? Which money service do you recommend? The best time to help is when the patient is ready to be discharged and there is a clear total on the bill, but there will be costs for medicines before that.
A request for medical help can come at any point in a relationship. Have you been here to meet the family? Do you know what they are like? Questions to ask yourself are, are these people truly poor, or do they have other resources they can draw upon in this situation? I would say that if you know they are very poor (Pick any two: live out of town, or in a squatter area, 1-2 room house/shack, keep a pig and chickens, kids go to public schools, small TV, no cable, one cell phone in the family) then go ahead and help as much as you can, if you want. But if they are middle class (Pick any two: home made of cement, have an air con unit, own a motorcycle or other vehicle, large TV with cable, kids attend private school, all have cell phones, own fighting cocks) then don’t pay the whole bill, just pay part and let them work out the rest. This establishes some limits to what you will do in the future as well. If they are using a private hospital, that indicates they have some money (or know you do). If they are in a government hospital, then they probably have some genuine needs.
Culturally, there is a lot of pressure on a girl who has a foreign boyfriend/fiance when the family has a need. She is one of the resources that the family will draw upon. If the need is genuine, she should not hesitate to give you more information about the medical situation, the hospital etc. How much you give is up to you.
My last bit of advise is, don’t loan the money, give it. If you must make a loan, never loan more than you can afford to never see again. If you are asked for a loan, you can compromise by giving what you can afford instead. Loaning money will just give you an ulcer and make you mad at the family because even between Filipinos, people do not tend repay loans unless the loaner can prove he now needs the money more than the loan-ee, and no one will think a foreigner needs money more than they do, as a rule. Of course there are exceptions, but until you know that the situation you are in is clearly one of those exceptions, give and don’t loan, or only loan what you can afford to give.
I hope this is helpful!
CORRECTION: Just this week I had a patient admitted to a local private hospital, so I am now up close and personal with this process. Yes, a down payment is required, the amount depending on the procedure. Having PhilHealth lowers the amount of down payment. It was P2,500.00 down for a normal birth, but they added an additional P10,000.00 when it became apparent that a c section would be needed.
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# 1 CHAS said:
Hi Lola,excellent,informative article.A few yrs ago i experienced a similar situation,it was a life/death situation,fortunately it was genuine as i new the person very well,and all relevant info was forthcoming without having to ask for it,and a life was saved.It is sad that this type of plea is a popular one used by scammers,sadly, i’m sure some genuine families may have suffered coz of lack of info and misunderstandings by foreigner friends who think they may be victims of a scam.As you point out,let common sense prevail.May i add from my own experience,medical emergencies in Phils can be traumatic for all concerned,even with a Philhealth policy.Except for Davao,there is no 911 no to call,no paramedic rushing to your aid,no airlift helicopters,you have to get yourself to hospital.Provincial hospitals are sometimes short of drugs, which have to be paid for up front at a Pharmacy and taken to the hospital.They also lack equipment,patients sometimes have to be transported for day trip to maybe a private hospital (hours away)for scans etc.which must be paid for up front.There is no after care,families have to provide this at home,inc medications,physio etc.A beautiful country it is,paradise it a’int.Regards Chas.
# 2 Dr. Sponk Long said:
Hi AmericanLola. Very true indeed….and another excellent article.
If I may add: There are also choices of hospital rooms.
The charity ward- the beds are free. Usually this is a big room with beds line up (like the infirmary in the movie “The Bridge of the River Kawai”). You bring in your own linens though.
A General Ward room usually consists of 4 or six(or more) patient-beds in a room.
A semi-private room- two beds (two patients) in a room.
A private room- one bed (one patient) in a room.
A suite- a big bed for one patient in a very big room. There also sofa chairs and usually are folding beds.
Intensive care unit beds of course are usually uniform and no choices there except in the very large private hospitals in Manila.
The prices of course differ markedly.
The thing to remember the most though is the doctor’s professional fee (PF) is based on the price of the room. Say the room costs P2000/day. The doctor’s fee is P2000/day of hospital stay. Now if there are three doctors seeing the patient- that will be P6000/day for the PF alone.
It may really add up very fast.
Cheers.
# 3 Bob (HI) said:
Very informative article with excellent advice. The comments by Dr. Sponk Long were also informative and appreciated. Thank-you!
# 4 AmericanLola said:
Thanks for your comments, chas, and you are right, having someone in the family admitted to the hospital is always traumatic. And the facilities available are not always the best, depending on the location and the hospital.
Thanks, Doc, that information is very helpful! I didn’t realize that the PF as related to the room cost. That is really good to know!
# 5 Dr. Sponk Long said:
Hi AmericanLola and Bob (HI) . Those are approximation of course and true mostly to cases in Internal Medicine and its subspecialty (Cardiology, Pulmonary, Endocrinology, Nephrology, etc.) and of course in Pediatrics.
Invasive procedures of course are bundled services and its best to negotiate the PF with the surgeon (including Gastroenterolgy, Obstetrics and Gynecology) before hand.
On a “lighter note” and not to digress from the main point of the article and also not to kick someone who is already down:
If one has to avail the charity ward, it is indeed free including food and including doctors’ PF. These wards (charity) are managed by the ‘House Officers’- doctors in residency training. These residents (doctors-in-training) have access to all specialists on staff in the hospital and usually are more than very willing to make avail of their advice and services for free. They see the patients themselves and perform surgeries with the residents.
Medications in the charity wards are for the most part are free coming from Pharmaceutical companies as samples or given gratis. There is also a very small amount of funds in the charity ward raised by the residents or endowments from local philantrophists or businesses.
Charity wards of course are relatively a bigger proportion in the real estate of government hospitals wards.
Charity ward funds also come from medical and nursing student tuitions.
If you are a charity ward patient you sign up your body to be a specimen for medical and nursing students. You’re privacy is nonexistent and they can come and ask you your history and be examined. You can be presented in an amphitheater full of students so you should’nt be the shy type.
Now, if you are a good Complete-Physical-Examination kind and it’s ‘Finals’ for the students, you wouldn’t want any student to fail for not doing a complete examination….would you?
So learn well how to say and very slowly: “palihug gamita ang imong ‘kumagko’ (”please use your ‘pinky’”). There can be 5-10 students a day. Those can really be long days.
# 6 AmericanLola said:
Yikes! How informative!
I thought the word for pinky was kumingking.
Well, I just sprung my gal (and her baby) from the hospital. The amount and variety of antibiotics used is staggering! They wanted to keep the baby in the hospital for a week on IV antibiotics because he might have swallowed meconium (newborn poop, for the uninformed). It is sterile and he did not inhale any. He is strong, no cough, looking great… But how will he be breast fed if Mama is 30 minutes away. NICU is happy to keep him and fed him the very expensive, hypo-allergenic formula… There is a nice sign in NICU which says “Breast milk is the best protection for babies,” but I don’t think they believe it.
# 7 Dr. Sponk Long said:
Hi AmericanLola. I stand corrected. I asked for a third opinion
here and ‘kumingking’ is the right word.
# 8 Cecilia said:
Informative and insightful post! Excellent comments! Everyone said it all. My cousin went back to the Philippines when his father got sick. He was shy to ask the doctor about her fee; discharge time, he was shocked to get hit with PhP 75,000 doctor’s bill [for 16 days of stay at the hospital].
# 9 Dave Starr said:
Very informative and helpful, AL, 9and the great commenters as well(.
The procu\edure for calling the hospital is a great idea. be advised, though, if you are already married into a Filipino famly your spouse may consider this the most bastos 9rude, horribkly improper) thing s/he has ever heard of. As a forigner on your own, fine advice. If already married, tread softly, epecially if the patient is someone ’senior’ in yearsor fmaily status … certain things are just not done.
I have long advocated and strongly do still that foreigners take the bull by the horns with immediate family 9the ones youwould be expected to help) that you get them PhilHealth in advance. It’s very cheap, 1200 a year for en entire family unit, and it does three things: shows thta you cna, eliminates the immediate requests for help in a hurry and sooner or later always b\pays off …even in private hospitals PhilHelath pays thousands per admisison.
Most Filipinos over 65 or 70 are already covered for free, but like eveythingelse there’s a form to fill up and people often won’t do this wihtout help. The way i deal with the sometimes maddening Filipino trait of not thinking about the future is, do something positive rather thna just moan about what will never chnage.
And swallow your pride. We were once faced wiht a very real request for help that my wife and I were unsure that we had the resources to support. I just told the requester, sorry, it is beyond our means right now. He has always respected me for that … I find many Westerners create their own problems by being too proud or embarrassed to say, “sorry, don’t have that much to spare.’
Your gifting advice is a gem also. Lending will alwyas cost more than you get back. I lent a close family member $600 once, for a very worthy cause. I have every penny back. But, my goodness, the hassles, hard feelings and agonizing on both sides of the fence must have added up to many times more than $600. i wish now I had gifted it and forgotten it.
# 10 Mike K. said:
Lola,
Would you believe I received a scam “medical emergency” from what I use to consider a friend in the states… I dated this girl for a few years before I moved to the Philippines and met my wife. I kept in touch with her as I considered her a friend… Then a while back I get a disturbing message that she is dying from cancer. As time goes on I find out it was all a scam to get money from her so called friends… Ha-ha guess that just adds to my long list of not trusting the American public.
I enjoy reading your insight as well as other ex-pats on the site. Keep up the good work…
Regards,
Mike K.
AKA:Kuya Mike
# 11 Cecilia said:
Here is an excerpt from my cousin’s email when an unmarried aunt (74 yrs old), sister of my father, was admitted in the semi-ward section of Makati Medical. Two of the attending surgeons were relatives and did not include their charges here. This was only for 2 wks last month.
“Just to recap I put down again what has been spent inthe hospital and those who contributed. Once again onbehalf of Tita, thank you for your generosity.”
Total Hospital Charges P 156,380.88
Surgeon PF 60,000.00
Anesthesiologist 13,440.00
Total Amt. PhP 229,820.88
Less: > > Discounts (Senior Citizen) 27,933.25
PhilHealth (as SSS retiree) 14,590.00
(The rest…donations from relatives…the remaining amt.=whoever has that person in charge.)
Because of age…opted out the chemo part.—This is the glaring reality of life in any 3rd world country.
I haven’t heard of any free hospitalization…unless it’s the gov’t hospital which the last time I know…[nevermind]…
If Dave Star has that information: free…65+ —[lol]—how come my family didn’t know that. My 81 yr-old uncle (this time, my mom’s brother) got almost the same discount (10%???) 3 months ago. Same as my mom’s 2 yrs ago and she was 73 then.
This is not counting us aging kids. One has to have a lot of sense of humor and much much more…that’s why it’s hard to claim that retirement bliss. When I retire, I’m not even sure if I want PhilHealth. Granting that I will pay P12,000/yr, and I don’t get sick at least 5 yrs…then I would be ahead if I just put the money in the bank. I’m not kidding; this is a real delemma for me.
# 12 Cecilia said:
I mean…an absolute dilemma!
# 13 AmericanLola said:
Thank you Cecillia for that look a the realities of medical care in the Philippines. Very helpful indeed! As you have clearly shown, Filipino families rely on each other to take care of these emergencies.
I like your idea of saving the cost of PhilHealth in case of need. Self insurance is indeed a good idea, but many here find saving money for future emergencies difficult to do, and also feel guilty if someone else in the family has a need. I have found people either keep such savings secret and feel guilty, or end up giving it to someone else. Do you agree?
My friends who just had a baby saved the whole nine months so that the birth would not be an emergency situation. The whole time her parents were constantly on her case to give them money for this need or that. It was hard to hold onto their savings, which they knew they would need, and turn down her parents. There was resentment on both sides. In the end, she had a C-section and they had almost all they needed to pay for the whole thing! We were really proud of them! We hope they will continue to keep some money aside for emergencies.
# 14 AmericanLola said:
Thanks for your good comments, Dave, Yes, I can see that you are right to advise caution in calling the hospital if your wife’s elderly aunt/mother, cousin, dad is the patient. I think this is especially true if you are already in country. Your Filipino spouse should be trusted with knowing the details.
The caution is for those whose girl friend, or wife-to-be has a family medical emergency and you don’t really know what is going on, or sounds a little fishy, you haven’t met the people involved, and generally think you could possibly be taken advantage of. In that case, going straight to the source of the information is a good idea. If that is insulting or offensive, (especially when you give less than hoped for) maybe the situation (relationship) needs to be re-evaluated.
# 15 Cecilia said:
Very true American Lola…you are indeed Filipinized now along that line and in so many ways–I’ve read somewhere that you can also fluently speak Cebuano? My hat is off to all foreigners who at least try to make an effort to bring smiles to the Filipinos even with a few smatterings of their dialects.
Actually, I’m just philosophizing to some extent why I should keep the money and not PhilHealth. Since I was growing up, I had to depend so much on blind Faith because there were more immediate things to take care of. That’s why most Filipinos are in the same boat. I was just so lucky that the Man Upstairs was smiling down on me.
We have a saying that amounts to ‘even the last spoonful of food you’re about to put in your mouth, you sometimes give it to the one who has nothing to eat’ just to make it through another day.