PDSS health insurance plan question. Ars humano

rmemo

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Dec 9, 2010
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My mom is in intensive care with encephalitis which is a severe swelling of the brain. She has been sick since November 15 and at the hospital since November 23rd.

She has ars humano pdss as her health plan as this is the plan of the law. For all employees in dr. The problem is that she has been covered since august/September so she doesn't qualify for the full 1,000,000 pesos coverage for catostraphic cases. She could only get up to 250,000 to 500,000 because of her short time with the insurance. Her ,medical bill is already at 800,000 in less than 1 month. She is still in icu but may come out of it in a week or 2. She has not woken up from her coma.

So in her plan it says it covers 85% medicine(this is at 400,000 for her) at hospital stays, and 85% for icu cost per day(7,500 she is being charged now) and 90% of doctors pay (I have paid them 80,000 so far and they want another 80,000 soon) and also 80% of xrays and lab results(this is at 100k for her)


My question is, does these % differ from catastrophic cases? I ask because it says it is unlimited in all cases of which I stated the % of. So of the medicine bill comes out to 1,000,000 I would only have to pay 150,000 correct?


Also for catastrophic cases it states it should not exceed 2 minimum wages pay(12,942). If this true them what happens In cases of over 1,000,000 pesos? Do I have to put more?
 

rmemo

New member
Dec 9, 2010
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ARS Humano


Thats her plan btw. Thanks for anyone who knows about this. I have left over 250,000 as a deposit but that is all I had left. This doesn't count MRI I have paid for and ambulances I paid for not knowing it was covered in her plan. My mom hasn't spoken since I have come to dr so she didn't get the chance to tell me about her plan in person. I am from USA but our roots are Dominican. At this current rate her medical bill could well be over 1.3 million pesos by the time she is released. Not counting 3 different rehab programs she must join. And out patient medication and general cost of living. I really can't afford this unless she is covered fully with this pdss insurance. Not to meant ion my flights from USA to dr and back to work and etc(need to make the money right lol)
 

Criss Colon

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Jan 2, 2002
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You should be having meetings with your insuranse providers,and the hospital.
Your questions are very complicated,so I doubt anyone here can give you the information you seek.
Cris Colon
 

lisagauss

Bronze
Feb 16, 2011
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I am really sorry to hear about that; it is very sad to see a loved one go through this. But CC is right, please sit down or get on the phone with the insurance company as they are the ones that can answer these questions for you.
 

dv8

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Sep 27, 2006
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you could call them at 809 200 4903, free of charge. the costs of hospital stay are always limited (costs can't exeed whatever amount of money daily).
 

rmemo

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Dec 9, 2010
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Thanks for the number. I asked here because my Spanish is not good at all. They often treat you bad if you don't speak Spanish clearly.
 

rmemo

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Dec 9, 2010
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Incase anyone wanted to know...

You have to earn the 1,000,000 pesos insurance by paying your insurance for 12 straight months. It starts at 150,000 and goes up every month a certain amount. The biggest jump is between the 3rd and 4th month, it goes from 250,000 covered to 500,000 covered.


Also all the medicines,xrays,lab results,doctors fee,icu stay and etc count towards the catastrophic limit. So it adds up quick, by my estimation the 1,000,000 pesos will cover you for about a month stay in intensive care.


Once you go to a regular room the cost become very manageable. They cover 80 to 85% of mostly everything. This is also good because the max coming out of your pocket for each catagory is 2 minimum wages(12,964 pesos)