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Frequently Asked Questions

FREQUENTLY ASKED QUESTIONS

Q. What happens if I’m advised for hospitalization?

If the admission order came from an accredited doctor of Eastwesthealthcare:

Simply present the admitting order together with your Eastwest Healthcare card at the Admitting Department of your chosen affiliated hospital. The hospital personnel of either the Admitting Section or the Emergency Room Unit will then coordinate with Eastwest Healthcare’s hotline for verification and assure seamless availment of your benefit. Once verified, members can then choose room accommodation based on his/her plan.

Due to call congestion during peak hours (10AM – 4PM), members may also want to text or miss call these numbers of Eastwest; 0908 868 6009 to 18 to facilitate faster coordination

If the admission order came from a NON-ACCREDITED doctor of Eastwesthealthcare:

All Eastwest Healthcare members has this unique privilege that they can be attended to by NON-ACCREDITED doctors in an ACCREDITED hospital. Simply follow the above procedure and upon discharge, pay for the cost of Professional Fee then you can file for reimbursement based on EASTWESTHEALTHCARE’S set professional fee limits or relative unit value (RUV).

Q. What if I want to seek consult with my private doctor who is not affiliated by EASTWEST HEALTHCARE and have series of tests

Members may file reimbursement for the consultation fee based on the set standard limits (RUV or relative unit value).  You can use your healthcard for the requested tests by following the outpatient/consultation procedure or call EWHC hotline for verification and approval.

Q. Do you cover cases due to Vehicular accident?

Yes, subject to standard exclusion provisions e.g violation of a city ordinance or law will not be covered etc. If the incident needs immediate medical attention, please rush to the nearest hospital and follow the emergency cases procedures.

Q. What if on the time of admission, there is no room available base on my plan?

It is best to call our hotline numbers for assistance or member may choose to do the following:

  • Member may meantime occupy a lower room category and transfer to his/her category once available.
  • Member may transfer to another affiliated hospital if it is a non- urgent case.
  •  Member may opt to avail of a room one level higher than his Room plan except Suite Room for the first twenty-four (24) hours of confinement. As standard, member will only be charged the room rate difference. If after 24hrs and for whatever reason; e.g. member refuses or if there is still no available room, member fails to transfer to his/her designated room category, all incrementals (rate difference of laboratory costs and ancillary services) including room and board excess, difference of professional fees incurred after the first twenty-four (24) hours shall be for the account of the member before discharged.

Q. Are your hotline call centers available even at midnight?

Yes, our customer service representatives man our hotlines 24/7 to assist members in their medical availments.

Q. Can I avail of medical services without Letter of Authorization (LOA)?

No, you cannot avail of any medical or dental services without a LOA. The LOA is a standard and basic document of ALL HMOs that would inform the hospitals/clinics that you have been authorized by EASTWEST HEALTHCARE to avail of medical benefits charged to EWHC. You may call us up, email, visit our website or proceed to the HMO office/coordinator of the clinic, medical or dental facility of your choice to secure an LOA.

Q. What happens if I fail to file my Philhealth upon discharge?

As standard, HMO benefits are exclusive of Philhealth benefit so members will be charged the Philhealth portion before discharged from the hospital.

Q. Is it true that I need to pay in cash for the professional fees of Neurologists?

Yes. Neurologists are not accepting HMOs due to the policy set by their Association. Member may pay for the cost of professional fees then file for reimbursement based on the Relative unit value (RUV).

Q. How do I avail of my dental benefits?

Members may call their preferred accredited dentist to set an appointment. Their staff will coordinate with our Customer Service Representative to secure an LOA/approval. Member should then go on the appointed date. 

Q. What if I lost my EASTWEST HEALTHCARE ID, how do I apply for a new card? Can I still avail of the medical services even without the card?

Lost cards should be reported immediately to your Human Resources for proper coordination of ID replacement with EASTWEST HEALTHCARE. Benefits can still be availed anytime with proper coordination with our hotline personnel for scheduled availments.  In case of emergencies, whenever possible you may call or message our hotline numbers; 0908 868 6009 to 18 to facilitate identification. Declare that you are a bona fide member of Eastwest Healthcare and present any valid ID to the Emergency Room personnel of the accredited facility for proper coordination with us.

Q. I just had my prenatal consultation from your accredited OB Gyne and she requested me to have an ultrasound. Is this covered?

No. As standard, maternity care and all other conditions related to and/or resulting from pregnancy and delivery including its complications is part of the general exclusion and limitations of all HMOs including EASTWEST HEALTHCARE.

Q. My sister needs to seek medical attention for her pain, yet she doesn’t have a health card membership. Is it possible for her to use my card?

No. EASTWEST HEALTHCARE membership is non- transferable.

Q. How does the HMO for outpatient and inpatient services work?

You may refer to the availment procedure for the process flow to use your healthcard for the outpatient and inpatient benefits.

Q. What are the requirements for reimbursement claims?

You may refer to the guidelines and requirements in processing reimbursement claims.

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