An HMO (Health Maintenance Organization) claim is a request for your private health plan — Maxicare, Intellicare, Medicard, Caritas, ValuCare, PhilCare, Pacific Cross, Avega, Cocolife Healthcare, EastWest Healthcare, etc. — to pay for a covered medical service. This is different from PhilHealth, which is the government's basic insurance and handles its own separate claims (see our PhilHealth guide). HMOs deny claims when they believe the service falls outside your policy — but Filipino consumers have the right to appeal, first internally with the HMO and then to the Insurance Commission (IC), the regulator that supervises HMOs under Executive Order 192 (2015). Most denials that get reversed are won on the internal appeal — not at the IC.

Ang HMO (Health Maintenance Organization) claim ay isang request sa private health plan mo — Maxicare, Intellicare, Medicard, Caritas, ValuCare, PhilCare, Pacific Cross, Avega, Cocolife Healthcare, EastWest Healthcare, atbp. — para bayaran ang medical service na covered ng plan mo. Iba ito sa PhilHealth, na siyang basic insurance ng gobyerno at may sariling separate na claims (tingnan ang aming PhilHealth guide). Tinatanggihan ng HMO ang claims kapag pakiramdam nilang nasa labas ito ng policy mo — pero may karapatan ang Pilipinong consumer na mag-appeal, una sa loob ng HMO mismo, tapos sa Insurance Commission (IC), ang regulator na nag-su-supervise sa mga HMO sa ilalim ng Executive Order 192 (2015). Karamihan ng nada-denial na natatanggal ay napapanalunan sa internal appeal — hindi sa IC.

Know the exact reason cited on your denial letter — your appeal will argue against that specific reason. Here's what each one means in plain language:

1. Pre-Existing Condition (PEC). Your HMO claims the illness existed before your coverage started or before the PEC waiting period (usually 1 year for most plans) ended. Common for diabetes, hypertension, asthma, thyroid disorders. Counter-argument: medical records showing the condition was diagnosed AFTER your effective date, or that this is a new acute episode unrelated to the prior condition.
2. Exclusion clause. The procedure or condition is explicitly excluded in your policy contract — cosmetic surgery, dental (unless added), congenital conditions, fertility treatment, mental health (in older plans), self-inflicted injury. Counter-argument: only valid if the exclusion is clearly written in the contract you signed. Ambiguous exclusions favor the insured.
3. No Letter of Authorization (LOA) / no pre-approval. For elective procedures, most HMOs require a written LOA before admission. If you went ahead without one, the HMO may deny. Counter-argument: emergencies don't require pre-approval, and verbal approvals (rare) are still binding if you can prove them.
4. Lapsed coverage. Your membership expired, your employer stopped paying, or you missed payment beyond the grace period. Counter-argument: proof of payment, employer certification of continued enrollment, or that the incident occurred while coverage was still active.
5. Late filing. Most HMOs require claims to be filed within 60-90 days after discharge. Past that, automatic denial. Counter-argument: serious illness or hospitalization that prevented timely filing is usually accepted as good cause.
6. Doctor or hospital out of network. You went to a non-accredited facility or saw a non-affiliated specialist. Counter-argument: in genuine emergencies, the HMO is required to cover the nearest available hospital regardless of network status.
7. ER not deemed an "emergency." The HMO reviews your ER visit and decides it didn't meet their definition of emergency (e.g., they classify it as a regular consultation). Counter-argument: the legal standard is the "prudent layperson" rule — what a reasonable person believes is an emergency at the time. Doctor's note explaining urgency is critical.

Alamin ang eksaktong dahilan na nakasulat sa denial letter mo — ang appeal mo ay laban sa specific na dahilang iyon. Ito ang ibig sabihin ng bawat isa sa simpleng wika:

1. Pre-Existing Condition (PEC). Sinasabi ng HMO na nagkaroon ka na ng sakit bago nagsimula ang coverage mo o bago natapos ang PEC waiting period (karaniwan 1 taon sa karamihan ng plans). Karaniwan sa diabetes, hypertension, asthma, thyroid disorders. Sagot: medical records na nagpapakita na nadiagnose ang sakit PAGKATAPOS ng effective date mo, o bagong acute episode ito na hindi related sa dating kondisyon.
2. Exclusion clause. Ang procedure o kondisyon ay malinaw na hindi sakop sa policy contract mo — cosmetic surgery, dental (maliban kung idinagdag), congenital conditions, fertility treatment, mental health (sa lumang plans), self-inflicted injury. Sagot: valid lang kung malinaw na nakasulat ang exclusion sa kontratang pinirmahan mo. Kung malabo ang exclusion, panalo ang insured.
3. Walang Letter of Authorization (LOA) / walang pre-approval. Para sa elective procedures, karaniwang nangangailangan ang HMO ng nakasulat na LOA bago ka ma-admit. Kung pumunta ka na walang LOA, pwedeng i-deny. Sagot: hindi kailangan ng pre-approval sa emergencies, at ang verbal approvals (bihira) ay binding pa rin kung mapatunayan mo.
4. Lapsed coverage. Expired ang membership mo, tumigil ang employer mo sa pagbabayad, o nakaligtaan mong magbayad lampas sa grace period. Sagot: proof of payment, employer certification ng continued enrollment, o na nangyari ang insidente habang aktibo pa ang coverage.
5. Late filing. Karamihan ng HMO ay nangangailangan ng claims na isumite sa loob ng 60-90 araw pagkatapos ma-discharge. Lampas doon, automatic denial. Sagot: grabeng sakit o hospitalization na pumigil sa iyong mag-file on time ay karaniwang tinatanggap bilang good cause.
6. Doctor o hospital na hindi sa network. Pumunta ka sa hindi accredited na facility o nagpatingin sa specialist na hindi affiliated. Sagot: sa tunay na emergency, dapat sakupin ng HMO ang pinakamalapit na hospital kahit hindi sa network.
7. ER hindi itinuturing na "emergency." Rini-review ng HMO ang ER visit mo at idine-decide nila na hindi ito emergency (hal., regular consultation lang daw). Sagot: ang legal standard ay "prudent layperson" rule — ano ang iisipin ng karaniwang tao na emergency sa oras na iyon. Mahalaga ang doctor's note na nagpapaliwanag ng urgency.

This is the single most important step — and the one most Filipinos skip. Verbal denials don't count. If the hospital admitting officer or HMO coordinator tells you over the phone or in person that your claim is denied, that is not a valid denial for appeal purposes.

What to demand

• A written denial letter (email is fine) on HMO letterhead, with: claim number, your name and policy number, the date of the incident, the specific clause or reason cited (e.g., "Section 4.2 — Pre-Existing Condition"), and the name + signature of the HMO officer.
• A copy of your policy contract if you don't have one. Your employer's HR or the HMO's member services can email it. You'll need to cite the exact clauses in your appeal.
• The complete computation of what they refused to pay — total bill, what was approved (if anything), what was denied, and the line items.

How to ask

Email the HMO's customer service or member relations the same day. Sample line: "Per Section 8 of the HMO Service Agreement and IC rules, I respectfully request a written denial letter for Claim #XXXX, citing the specific policy clause that supports the denial, so that I may exercise my right to appeal. Please send within 5 working days."

Save everything. Take screenshots of every chat, save every email, photograph every paper document. You will need this paper trail for both the internal appeal and the IC complaint.

Ito ang pinakamahalagang hakbang — at ang pinakamadalas na-skip ng mga Pilipino. Hindi binibilang ang verbal denials. Kung sinabi sa iyo ng admitting officer ng hospital o HMO coordinator sa telepono o personally na denied ang claim mo, hindi iyon valid denial para sa appeal.

Ano ang hihingin

• Nakasulat na denial letter (okay lang ang email) sa HMO letterhead, kasama: claim number, pangalan at policy number mo, petsa ng insidente, specific clause o dahilan (hal., "Section 4.2 — Pre-Existing Condition"), at pangalan + pirma ng HMO officer.
• Kopya ng policy contract mo kung wala ka. Pwedeng i-email ng HR ng employer mo o ng member services ng HMO. Kakailanganin mong i-cite ang eksaktong clauses sa appeal mo.
• Buong computation ng tinanggihan nilang bayaran — total bill, ano ang inapprove (kung mayroon), ano ang denied, at ang bawat line item.

Paano hingin

Mag-email sa customer service o member relations ng HMO sa parehong araw. Sample line: "Per Section 8 ng HMO Service Agreement at IC rules, magalang kong hinihiling ang nakasulat na denial letter para sa Claim #XXXX, na nakasaad ang specific policy clause na sumusuporta sa denial, upang magamit ko ang aking karapatang mag-appeal. Pakipadala sa loob ng 5 working days."

I-save ang lahat. Mag-screenshot ng bawat chat, i-save ang bawat email, kunan ng litrato ang bawat papel. Kakailanganin mo itong paper trail para sa internal appeal at IC complaint.

Most HMOs have an internal review body — often called the Appeals Review Committee (ARC) or Adjudication Committee (AC). The Insurance Commission requires you to exhaust this internal remedy BEFORE filing with the IC. Skip this step and the IC will dismiss your complaint outright.

Filing window

Most HMO contracts give you 15-30 days from receipt of the denial letter to file an internal appeal. Check your policy for the exact deadline. Miss the window and you forfeit your appeal rights — file even an incomplete appeal first, supplement evidence later.

How to file

1. Address your appeal letter to the HMO's Appeals Review Committee / Adjudication Committee. Copy (cc) member services and your employer's HR if it's a corporate plan.
2. Send via two channels — email AND registered mail / courier with proof of delivery. Email alone can be "lost."
3. Attach everything — denial letter, policy contract pages cited, doctor's letter explaining medical necessity, complete medical records, original ORs and statement of account, photos of receipts, ID copy.
4. Request a written response within the timeframe your contract specifies (usually 15-30 days after they receive your appeal).
5. If they ignore you past their own deadline, treat that as a constructive denial and proceed to the IC.

See the sample appeal letter template below.

Karamihan ng HMO ay may internal review body — madalas tinatawag na Appeals Review Committee (ARC) o Adjudication Committee (AC). Hinihingi ng Insurance Commission na ubusin mo muna ang internal remedy BAGO mag-file sa IC. Kung ni-skip mo ito, basta-basta ide-dismiss ng IC ang complaint mo.

Filing window

Karamihan ng HMO contract ay nagbibigay sa iyo ng 15-30 araw mula sa pagkatanggap ng denial letter para mag-file ng internal appeal. I-check ang policy mo para sa eksaktong deadline. Kung lumagpas, mawawala ang karapatan mong mag-appeal — mag-file kahit incomplete pa, dagdagan ng ebidensya pagkatapos.

Paano mag-file

1. Iaddress ang appeal letter sa Appeals Review Committee / Adjudication Committee ng HMO. I-cc ang member services at HR ng employer kung corporate plan.
2. Ipadala sa dalawang channel — email AT registered mail / courier na may proof of delivery. Pwedeng "mawala" ang email lang.
3. I-attach ang lahat — denial letter, mga pahina ng policy contract na cited, sulat ng doctor na nagpapaliwanag ng medical necessity, kumpletong medical records, originals ng OR at statement of account, litrato ng mga resibo, kopya ng ID.
4. Humingi ng nakasulat na sagot sa loob ng panahon na specified sa contract mo (karaniwan 15-30 araw pagkatanggap nila ng appeal mo).
5. Kung ini-ignore ka nila lampas sa sarili nilang deadline, ituring na constructive denial at lumipat sa IC.

Tingnan ang sample appeal letter template sa baba.

If the internal HMO appeal is denied — or if the HMO fails to respond within its own timeframe — escalate to the Insurance Commission (IC). HMOs are regulated by the IC under Executive Order 192 (2015), which transferred HMO supervision from the Department of Health to the IC.

Where to file

• Insurance Commission Public Assistance and Mediation Division (PAMD) — the front line that handles consumer complaints, including HMO disputes.
• Website: insurancecommission.gov.ph
• Main office: 1071 United Nations Avenue, Manila (verify current address on the IC website — they have regional offices as well).
• Email: verify the current PAMD email on the IC website before sending. The IC publishes the official complaints email and contact directory under the "Contact Us" page.

What to file

The IC uses a Complaint Form (often called CR-Form / "Complaint Form"). Download the current version from the IC website — do not use unofficial templates floating around social media.

• Verified complaint (notarized statement of facts) — name, address, policy number, HMO name, dates, specific relief sought (e.g., "I respectfully pray that respondent HMO be ordered to pay the denied claim of ₱[amount] plus damages and interest").
• Annexes: denial letter, internal appeal letter + proof of submission, HMO's response (or proof of non-response), policy contract, medical records, ORs, statement of account, doctor's letter, valid ID.

Timeline at the IC

• Docketing: IC reviews your complaint, dockets it (assigns a case number), and serves notice on the HMO — typically a few weeks.
• HMO response: after docketing, the HMO is given a window (commonly 15 days) to file a written answer.
• Mediation: PAMD attempts to mediate. Many cases settle here.
• Adjudication: if mediation fails, the case proceeds to formal adjudication before the Insurance Commissioner — this is where the bulk of the 4-6 month total timeline sits.

Possible outcomes

• Settlement — HMO agrees to pay all or part of the claim, sometimes with interest.
• Order to pay — IC formally orders the HMO to pay the disputed amount, plus possible legal interest (6% per annum is the prevailing rate under Nacar v. Gallery Frames) and administrative penalties.
• Dismissal — if the IC finds the denial valid under the contract. You may appeal further to the Court of Appeals.
• Sanctions on the HMO — warnings, fines, suspension, or license revocation for repeated bad-faith denials.

Filing fees

IC complaints are generally free of filing fees for consumer complaints under the PAMD. You only pay for notarization of your verified complaint (₱100-₱300 at a typical notary public) and courier/mail costs.

The DOH role

Under EO 192, primary regulatory authority for HMOs sits with the IC. The Department of Health (DOH) still has a role in healthcare service quality (e.g., complaints against the HOSPITAL itself for substandard care). For pure claim-payment disputes, the IC is your venue. If your case involves both a denial AND a quality-of-care complaint, file with the IC for the claim and with DOH separately for the hospital service issue.

Kung tinanggihan ang internal HMO appeal mo — o kung hindi sumagot ang HMO sa sarili nilang timeframe — i-escalate sa Insurance Commission (IC). Regulated ang HMO ng IC sa ilalim ng Executive Order 192 (2015), na naglipat ng HMO supervision mula DOH papuntang IC.

Saan mag-file

• Insurance Commission Public Assistance and Mediation Division (PAMD) — ang frontline na humahawak ng consumer complaints kasama ang HMO disputes.
• Website: insurancecommission.gov.ph
• Main office: 1071 United Nations Avenue, Manila (i-verify ang kasalukuyang address sa IC website — may mga regional offices din sila).
• Email: i-verify ang kasalukuyang PAMD email sa IC website bago magpadala. Pina-publish ng IC ang opisyal na complaints email at contact directory sa "Contact Us" page.

Ano ang i-fa-file

Gumagamit ang IC ng Complaint Form (madalas tinatawag na CR-Form / "Complaint Form"). I-download ang current version sa IC website — huwag gumamit ng unofficial templates sa social media.

• Verified complaint (notarized statement of facts) — pangalan, address, policy number, pangalan ng HMO, mga petsa, specific relief na hiningi (hal., "Magalang kong hinihiling na utusan ang respondent HMO na bayaran ang tinanggihang claim na ₱[amount] kasama ang damages at interes").
• Annexes: denial letter, internal appeal letter + proof of submission, sagot ng HMO (o proof na hindi sumagot), policy contract, medical records, ORs, statement of account, sulat ng doctor, valid ID.

Timeline sa IC

• Docketing: rini-review ng IC ang complaint mo, dini-docket (binibigyan ng case number), at pinapadalhan ng notice ang HMO — karaniwang ilang linggo.
• Sagot ng HMO: pagkatapos ng docketing, binibigyan ang HMO ng window (karaniwan 15 araw) para mag-file ng nakasulat na sagot.
• Mediation: sinusubukan ng PAMD na mag-mediate. Maraming kaso ang nareresolba dito.
• Adjudication: kung hindi nag-succeed ang mediation, dadalhin ang kaso sa formal adjudication sa harap ng Insurance Commissioner — dito kumakapal ang 4-6 buwan na kabuuang timeline.

Posibleng resulta

• Settlement — pumayag ang HMO na bayaran ang buo o bahagi ng claim, minsan may interes.
• Order to pay — pormal na inutusan ng IC ang HMO na bayaran ang tinaltalan na halaga, kasama ang posibleng legal interest (6% kada taon ang prevailing rate sa ilalim ng Nacar v. Gallery Frames) at administrative penalties.
• Dismissal — kung makita ng IC na valid ang denial sa ilalim ng kontrata. Pwede mong i-appeal pa sa Court of Appeals.
• Sanctions sa HMO — warnings, fines, suspension, o revocation ng lisensya kung paulit-ulit ang bad-faith denials.

Filing fees

Ang IC complaints ay sa pangkalahatan ay libre — walang filing fees para sa consumer complaints sa ilalim ng PAMD. Magbabayad ka lang ng notarization ng verified complaint mo (₱100-₱300 sa karaniwang notary public) at gastos sa courier/mail.

Papel ng DOH

Sa ilalim ng EO 192, ang primary regulatory authority sa HMOs ay nasa IC. May papel pa rin ang Department of Health (DOH) sa quality ng healthcare service (hal., reklamo laban sa HOSPITAL mismo para sa substandard care). Para sa pure claim-payment disputes, IC ang lugar mo. Kung sangkot ang denial AT quality-of-care complaint, mag-file sa IC para sa claim at hiwalay sa DOH para sa hospital service issue.

Copy, edit with your specifics, print, sign, and send. Keep it factual and unemotional — appeals get reviewed by committees, not by the agent who denied you.

Kopyahin, i-edit ng sariling detalye, i-print, pirmahan, at ipadala. Panatilihing factual at hindi emosyonal — komite ang nag-re-review ng appeal, hindi ang agent na tumanggi sa iyo.

Gather these BEFORE you draft the appeal. Missing documents are the most common reason appeals fail.

• Denial letter (written, on HMO letterhead, with specific clause cited)
• Policy contract — especially the pages that list covered benefits, exclusions, and the appeal procedure
• Membership card / certificate of coverage showing your active dates
• Proof of premium payment — payroll deduction record, GCash/bank receipts, or employer certification
• Complete medical records — admission notes, discharge summary, lab results, imaging reports, operative records
• Doctor's letter of medical necessity — explicitly stating the procedure was necessary, the diagnosis is acute (if PEC denial), and the urgency level (if ER denial)
• Original ORs for all amounts paid out of pocket, plus the hospital's final statement of account
• Photocopies of every relevant page of the medical chart (request from hospital records, ₱100-₱500 fee typical)
• Email and chat transcripts with HMO coordinators, doctors, hospital admitting
• Valid government ID (PhilSys, passport, driver's license)
• SPA (Special Power of Attorney) if someone else is filing on behalf of an incapacitated or deceased member

Tipunin ang mga ito BAGO mag-draft ng appeal. Ang pinakakaraniwang dahilan ng failed appeal ay kulang sa dokumento.

• Denial letter (nakasulat, sa HMO letterhead, may specific clause na nakasaad)
• Policy contract — lalo na ang mga pahinang naglalaman ng covered benefits, exclusions, at appeal procedure
• Membership card / certificate of coverage na nagpapakita ng active dates mo
• Proof of premium payment — payroll deduction record, GCash/bank receipts, o employer certification
• Kumpletong medical records — admission notes, discharge summary, lab results, imaging reports, operative records
• Sulat ng doctor para sa medical necessity — malinaw na nakasaad na necessary ang procedure, acute ang diagnosis (kung PEC denial), at antas ng urgency (kung ER denial)
• Original ORs para sa lahat ng halagang binayaran mo out of pocket, kasama ang final statement of account ng hospital
• Photocopies ng bawat relevant na pahina ng medical chart (hingiin sa hospital records, karaniwan ₱100-₱500 ang fee)
• Email at chat transcripts sa HMO coordinators, doctors, hospital admitting
• Valid government ID (PhilSys, passport, driver's license)
• SPA (Special Power of Attorney) kung iba ang nag-fa-file para sa incapacitated o namatay na member

Scenario 1: "Pre-Existing Condition"

Your HMO says your hypertension was pre-existing and refuses to pay for the related hospitalization. What to argue: Get your full medical history from your primary doctor or PhilHealth records. If your first diagnosis date is AFTER your coverage effective date — and beyond the PEC waiting period if your contract has one — the denial fails. If the current episode is an acute event (e.g., a hypertensive crisis from a new trigger), it's a separate clinical event, not a continuation of the pre-existing condition.

Scenario 2: "Not an Emergency"

You went to the ER for severe chest pain at 2 AM; turned out to be acute gastritis, not a heart attack. HMO denies, saying it wasn't a "real" emergency. What to argue: the prudent layperson standard — what a reasonable person would believe at the time. Severe chest pain reasonably looks like cardiac. Get the ER physician's note specifying that the symptoms warranted emergency evaluation.

Scenario 3: "Procedure Not Covered"

You needed a procedure (e.g., specific MRI, sleep study, certain biopsy) and the HMO says it's not in the covered list. What to argue: read your policy contract carefully — coverage clauses often say "diagnostic procedures medically necessary for [list]." If the procedure was medically necessary for a covered condition, the denial may be reversible. Doctor's letter explaining medical necessity is essential here.

Scenario 4: "Doctor Not in Network"

You consulted with a specialist who turned out not to be HMO-accredited. What to argue: (a) Did the HMO referral or accreditation list include this doctor at the time of consult? Print screenshots from the HMO portal if it did. (b) Was it an emergency or after-hours? Emergency exceptions usually apply. (c) Did your HMO coordinator verbally direct you to that doctor? Even though verbal approvals are weak, document any names and call times.

Scenario 5: "Late Filing"

You filed your claim 95 days after discharge, beyond the 90-day window. What to argue: good cause for delay — continued hospitalization, recovery from major surgery, mental incapacity, death in the family, or HMO miscommunication. Provide a doctor's certificate or sworn statement explaining the delay.

Senaryo 1: "Pre-Existing Condition"

Sinasabi ng HMO mo na pre-existing ang hypertension mo at tumatangging magbayad ng related hospitalization. Ano ang i-aargue: Kunin ang full medical history mo sa primary doctor o PhilHealth records. Kung ang unang diagnosis date mo ay PAGKATAPOS ng coverage effective date mo — at lampas sa PEC waiting period kung may ganoon ang contract mo — bagsak ang denial. Kung ang current episode ay acute event (hal., hypertensive crisis mula sa bagong trigger), separate clinical event ito, hindi pagpapatuloy ng pre-existing condition.

Senaryo 2: "Hindi Emergency"

Pumunta ka sa ER dahil sa matinding chest pain alas-2 ng madaling araw; lumabas na acute gastritis pala, hindi heart attack. Tinanggihan ng HMO, sabing hindi "tunay" na emergency. Ano ang i-aargue: ang prudent layperson standard — ano ang iisipin ng karaniwang tao sa oras na iyon. Ang matinding chest pain ay parang cardiac talaga ang itsura. Kunin ang note ng ER physician na nagsasaad na ang mga symptoms ay nangangailangan ng emergency evaluation.

Senaryo 3: "Hindi Covered ang Procedure"

Kailangan mo ng procedure (hal., specific MRI, sleep study, certain biopsy) at sabi ng HMO wala ito sa covered list. Ano ang i-aargue: basahing mabuti ang policy contract mo — madalas sa coverage clauses, "diagnostic procedures medically necessary for [list]." Kung medically necessary ang procedure para sa covered condition, pwedeng baliktarin ang denial. Mahalaga dito ang doctor's letter na nagpapaliwanag ng medical necessity.

Senaryo 4: "Doctor na Hindi sa Network"

Nagpatingin ka sa specialist na lumabas na hindi HMO-accredited. Ano ang i-aargue: (a) Nasa HMO referral o accreditation list ba ang doctor na ito noong oras ng konsulta? Mag-print ng screenshots sa HMO portal kung oo. (b) Emergency ba o after-hours? Karaniwang valid ang emergency exception. (c) Verbally ka ba inutusan ng HMO coordinator na pumunta doon? Kahit mahina ang verbal approvals, idokumento ang mga pangalan at call times.

Senaryo 5: "Late Filing"

Nag-file ka ng claim 95 araw pagkatapos ng discharge, lampas sa 90-day window. Ano ang i-aargue: good cause sa delay — patuloy na hospitalization, recovery mula sa major surgery, mental incapacity, namatay sa pamilya, o HMO miscommunication. Mag-provide ng doctor's certificate o sworn statement na nagpapaliwanag sa delay.

Customer service numbers change frequently. Always verify the current number on the HMO's official website before calling. Use these as a starting reference only:

• Maxicare — Member helpline; verify current number at maxicare.com.ph
• Intellicare — Member helpline; verify current number at intellicare.com.ph
• Medicard — Member helpline; verify current number at medicardphils.com
• Caritas Health Shield — Member helpline; verify current number at caritashealthshield.com.ph
• ValuCare — Member helpline; verify current number at valucare.com.ph
• PhilCare — Member helpline; verify current number at philcare.com.ph
• Pacific Cross — Member helpline; verify current number at pacificcross.com.ph
• Cocolife Healthcare — Member helpline; verify current number at cocolife.com
• EastWest Healthcare — Member helpline; verify current number at eastwesthealthcare.com

Insurance Commission Public Assistance and Mediation Division (PAMD): verify the current direct line and email on the IC website insurancecommission.gov.ph under "Contact Us." The IC also has regional offices in Cebu and Davao.

Madalas nagbabago ang customer service numbers. Palaging i-verify ang kasalukuyang numero sa opisyal na website ng HMO bago tumawag. Gamitin lang ang mga ito bilang starting reference:

• Maxicare — Member helpline; i-verify ang kasalukuyang numero sa maxicare.com.ph
• Intellicare — Member helpline; i-verify ang kasalukuyang numero sa intellicare.com.ph
• Medicard — Member helpline; i-verify ang kasalukuyang numero sa medicardphils.com
• Caritas Health Shield — Member helpline; i-verify ang kasalukuyang numero sa caritashealthshield.com.ph
• ValuCare — Member helpline; i-verify ang kasalukuyang numero sa valucare.com.ph
• PhilCare — Member helpline; i-verify ang kasalukuyang numero sa philcare.com.ph
• Pacific Cross — Member helpline; i-verify ang kasalukuyang numero sa pacificcross.com.ph
• Cocolife Healthcare — Member helpline; i-verify ang kasalukuyang numero sa cocolife.com
• EastWest Healthcare — Member helpline; i-verify ang kasalukuyang numero sa eastwesthealthcare.com

Insurance Commission Public Assistance and Mediation Division (PAMD): i-verify ang kasalukuyang direct line at email sa IC website insurancecommission.gov.ph sa ilalim ng "Contact Us." May regional offices din ang IC sa Cebu at Davao.