Frequently Asked Questions
Q. How does EastWest determine whether an admission is covered or not?
This is based solely on the provisions of the Service Agreement or Contract.
In general, most illness/conditions are covered except Cosmetic treatments/procedures, and all illness/conditions enumerated under "Exclusions and Limitations" of the Contract
Q. What is "in-network" and "out-network"?
In-network refers to the services of EastWest-Accredited doctors within EastWest-accredited hospitals. They are usually identified in the listing supplied to all members.
Out of network refers to the services of non-accredited doctors whether or not they are in within an EastWest accredited hospital.
Q. Who pays for expenses not covered by EastWest?
The member pays for this, unless the company elects to shoulder the bills.
Q. Why is there a need to pass through a Medical Coordinator?
The Medical Coordinator should be viewed as your "EastWest Family Doctor". They are responsible for the overall maintenance of your health. They also insure continuity of your case. As such, they must be aware of, and actively in charge of all activities related to your health, including referrals to the Specialist if needed.
Q. What happens if a member is admitted to an accredited doctor?
As defined above, this is "out of network" and will be solely for the member's account unless it is an emergency admission, or the Benefit Plan availed of has a provision for such, EastWest representative will advise the member of his/her alternatives.
Q. Can a member refer himself directly to the Specialist without passing through the coordinator?
No, he/she must first coordinate this with his "EastWest Family Doctor or Coordinator".
Q. If the preferred doctor is not around, with whom can I seek consultation for non-emergency?
To prevent this situation, set a appointment with the Doctor prior to the consultation. In this way, you are assured that a Doctor will attend to you when you come in to the clinic for the appointment. However, should you find yourself in this predicament, either (1) Go to EastWest Coordinator nearest you; or (2) Call the EastWest Hotline Tel No. 7509000
Q. What do you mean by incremental rate? Why do I have to pay it?
This is charged by the hospital when you occupy a room higher that you designated room rate, and is applied usually to all expenses aside from the room and board (medicines, lab, supplies, and other expenses).
Q. If I want my own doctor who is not EastWest-accredited to operate on me, will EastWest pay for my hospital bills if I shoulder the doctor's fees?
EastWest normally does not allow this arrangement because we strongly encourage using our own network for all medical services. On a case-to-case basis and subject to the approval of EastWest Medical Director, this maybe permitted. For cases that are allowed, ALL professional fees associated with the case will be shouldered by the patients and EastWest will shoulder only the covered hospital charges (excess room and bard, incremental etc.). EastWest tries to limit these arrangements due to the considerable administrative demands imposed.
Q. What comprises Annual Physical Exam (APE)?
This usually is composed of the physical examination, CBC, urinalysis, stool exam, and chest X-Ray. Pap Smear is advised and covered for women above 35 years old. The actual APE may be tailored to fit the healthcare needs of the Member based on the EastWest Doctor's assessment of the member.