FAQ new - ValuCare

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Frequently Asked Questions

Find answers to common questions and learn more about our services with our comprehensive FAQ section. Whether you have inquiries about coverage details, enrollment processes, benefits, or any other aspect of our offerings, we’ve got you covered. Explore our FAQs to get quick and clear answers to help you make informed decisions.

What if no ValuCare representative is around? Can I still use my benefits at accredited ValuCare clinics or hospitals?

Yes, definitely! Whether it’s an outpatient visit, hospital stay, emergency care, or claim reimbursement, follow these simple steps to get the care and support you need.

OUTPATIENT CARE

Fastest option: ValuCare SuperApp

1. Open the SuperApp → Accept Privacy Terms.
2. Tap “Request LOA” → Enter appointment details (date, reason).
3. Choose your provider:

● Scan QR code at the facility, OR
● Search preferred doctor by name & specialty → select hospital/clinic, OR
● Search facility by name or location.
● Upload doctor’s request for laboratory procedure

4. Get your LOA instantly

● Consultations → Approved immediately
Labs & Diagnostics → Approved within minutes

5. Download & print 2 copies → Present with yourValuCareCard + valid ID.

Alternative Options:

● Onsite: Visit an accredited facility with your doctor’s request (if needed), ValuCare Card, and valid ID to requestan LOA.
● 24/7 Customer Care Hotline: Call to request an LOA; issuance follows verification.

INPATIENT CARE
Fastest option: ValuCare SuperApp
1. 1. Open the SuperApp → Tap “Request LOA” → Select Inpatient.
2. 2. Enter your prescribing doctor’s name and hospital.
3. 3. Upload your doctor’s admitting order. Submit your request (processing time: up to 5 mins).
4. Present approved LOA with your ValuCare Card + valid ID at hospital admission.
  
  Alternative Options
  - ● At the Hospital: Go to a ValuCare-accredited facility with your admitting order, ValuCare Card, and valid ID.ValuCare will issue your LOA after verification.
  - ● 24/7 Customer Care Hotline
  Before discharge, remember to:
  - ● File your PhilHealth documents.
  - ● Review your hospital charge slips.
  - ● Settle any non-covered charges.
    
    EMERGENCY CARE
    - ● Proceed to the ER of any ValuCare-accredited hospital and present your ValuCare Card and Valid ID.
    - ● ER personnel will provide treatment immediately.
    - ● After treatment:
    - ● If admitted → Follow Inpatient Procedures.
    - ● If NOT admitted → Upon ER discharge:
    - ● Sign necessary documents.
    - ● Check hospital charge slips.
    - ● Settle any non-covered charges, if any.

If the hospital is accredited but the attending doctor is NOT accredited, what will ValuCare cover?

● If you choose a non-accredited doctor (regular case):

The case will not be covered because services from non-accredited doctors are listed under ValuCare’s Exclusions & Limitations, except for emergency cases.
● If your plan includes Point of Service (POS):
You may claim reimbursement for eligible expenses, following ValuCare’s reimbursement guidelines.
● If there is no accredited specialist available in that accredited hospital:
ValuCare will:
● Cover the hospital bills (subject to MCB, Exclusions & Limitations).
● Reimburse the doctor’s professional fee, following standard reimbursement procedures.

If I don’t have coverage for a pre-existing condition (PEC) or my coverage is already used up—and the diagnosis is not yet confirmed—can I still be accommodated?

Yes, we will assist you, but your coverage will depend on the final diagnosis.

● If you are confined, a ValuCare Hospital Liaison Officer will visit you within 24 hours (or call you ifyou’re in a provincial area) to explain your case.
● Your coverage will depend on the diagnosis given by the accredited attending doctor.
● If the doctor has not yet established a diagnosis, ValuCare cannot cover the case until the diagnosisis confirmed.
● If you pay the hospital bill first and the final diagnosis is covered, ValuCare will reimburse 100% ofapplicable hospital bills and professional fees, based on ValuCare’s reimbursement policy andprocedures.

Can I get outpatient care or medical consultation on Sundays?

Most hospitals don’t have outpatient doctors on Sundays (only ER services are available foremergencies).

For help, call ValuCare’s 24/7 Customer Service at (02) 8702-3310. We can guide you to the nearestaccredited clinic that’s open on Sundays.

You can also check the SuperApp’s clinic directory

If the hospital is not accredited but the attending doctor is accredited, what is the coverage?

● Call ValuCare’s 24/7 in transferringCustomer Service Hotline (02-8702-3310) for assistance in transferring to an accredited hospital, if medicallypossible (for admitted cases).
● Emergency cases may be eligible for reimbursement, subject to ValuCare’spre-existing condition rules, exclusions, limitations, and reimbursementprocedures.
● Non-emergency cases are not covered if the hospital is not accredited.

If I’m admitted and prefer my own personal doctor to manage my care, what will ValuCare do?

● We’ll gently explain that it’s not medically advisable to have two doctors from the samespecialty managing your treatment at the same time. This is to make sure your care iscoordinated and safe.
● If you still prefer your non-accredited personal doctor, you may do so — but theirprofessional fee will be at your own expense.
● ValuCare will continue to support your care by covering only the prescriptions andmedical orders issued by your accredited doctor.

Upon availing, accredited provider did not honor VC Card & decline accommodation

• Immediately call ValuCare Customer Service Hotline (02-8702-3310) for assistance.

• ValuCare Customer Service will ask for the nature of the member’ case. If case can be covered by the program, ValuCare customer representative will call the provider to endorse immediate accommodation of the member.

• For reasons outside the member’ program, ValuCare upon receiving the complaint will immediately investigate the case through proper coordination with the accredited provider involve. Also provide feedback and/or resolution to member may it be in a verbal or written form as case requires.

If my child or I show symptoms of Dengue but the ValuCare Coordinator says it can still be managed as an outpatient case, can I insist on being admitted?

You may request admission, but ValuCare can only provide coverage based on the accredited doctor’sdiagnosis and medical recommendation.

● The ValuCare Coordinator’s advice is based on your laboratory results and the accredited doctor’sassessment.
● If the accredited doctor determines that your case can still be managed outpatient, you need tofollow this medical order to keep your ValuCare coverage active.
● Under ValuCare’s General Exclusions & Limitations (Article 6.5 – Refusal to Comply withTreatment), ValuCare is not obligated to provide coverage if a member refuses the recommendedtreatment or insists on confinement when the accredited doctor has advised outpatient care.

In short: You may choose to be admitted, but the admission will not be covered if the accredited doctorrecommends outpatient management.

If VC Card is not available or has not been brought by member during availing, what will he do?

• Immediately call ValuCare Customer Service (if possible) and ask for assistance or your membership code.

• Clearly declare status of your ValuCare membership to ValuCare Plan Coordinator and present any valid ID (present membership code if available) for verification.

• For emergency case, proceed directly to emergency room and declare you’re a member of ValuCare. Emergency room personnel will call ValuCare Customer Service Hotline to verify your membership with ValuCare.

If I want to know my current remaining Maximum Coverage Benefit (MCB), what should I do?

● Contact ValuCare’s 24/7 Customer Service Hotline at (02) 8702-3310 or reach out to youraccount manager and request your updated MCB.
● After verifying your identity, our Customer Service representative or your Account Managerwill provide you with your latest MCB balance.

What if another surgical procedure was done during the operation as medically advised—how will ValuCare compute the coverage?

ValuCare will first coordinate with the hospital and review the operative records to properly assess thecase.

If the second procedure is not covered:

● ValuCare will only cover the charges related to the covered procedure.
● All expenses related to the non-covered procedure (hospital bills and professional fees) will beshouldered by the member upon discharge.

If the second procedure is covered:

● The professional fee for the second procedure will be charged separately to the Professional FeeMCB.
● Hospital charges for the second procedure will share the same MCB as the first procedure, followingValuCare’s Special Procedures policy.
● All applicable limits are subject to:
● Maximum Coverage Benefit (MCB)
● Pre-Existing Condition provisions
● Exclusions & Limitations
● Incidental expenses
● The coverage limit for procedures that require confinement already includes the room and board,operating room fees, doctors’ fees, and all related hospital charges.

If a member receives government-subsidized discounts, will these reduce their MCB?

• No. Government discounts will not be deducted from your Maximum Coverage Benefit (MCB).
• We encourage members to use these discounts so they can stretch and maximize their MCB.

What if an accredited doctor asks me to pay extra professional fees for a procedure or treatment that is already covered by ValuCare?

You should not be charged extra for services that are covered by your ValuCare plan.

If this happens:

1. Call the 24/7 ValuCare Customer Care Hotline immediately at (02) 8702-3310 or email 24hrs@valuecarehealth.com for assistance.
2. Accredited doctors and hospitals are not allowed to ask for additional payment for covered services, except in these situations:

● You chose a higher room and board than what your plan covers.
● There is a special case that has been approved and coordinated with the ValuCare Head Office.

3. Do not make private payment arrangements with accredited doctors. Any payment agreement made without ValuCare’s knowledge or approval will not be covered or reimbursed by ValuCare.

I was injured in a motorcycle accident, but the police report says I was at fault. Will ValuCare cover or reimburse my expenses?

ValuCare covers motor vehicle accidents only if you’re not at fault. For covered cases, you must file a Deed of Subrogation, which lets ValuCare recover treatment costs from the at-fault party. If the police report says you are at fault, the case won’t be covered.

Are all members entitled to an Executive Check-Up (ECU)? Is there a difference between ECU and Annual Physical Exam (APE)?

● Not all members are entitled to an ECU; it depends on your plan provisions.
● Difference between ECU and APE:

1. Scope:

● Annual Physical Exam (APE): Basic yearly preventive check-up including medicalhistory assessment, CBC, chest X-ray, urine and stool exams, ECG, and Pap smear(for members 35+).
● Executive Check-Up (ECU): More comprehensive; covers multiple body systems withadditional tests and procedures.

2. Location:

● APE: Usually at an accredited clinic; occasionally at an accredited hospital if no clinicis nearby.
● ECU: Always at an accredited hospital.
● Both APE and ECU are scheduled appointments.

If a member’s running bill exceeds the MCB, can they choose whether ValuCare covers the hospital bills or the professional fees?

• Yes. The member may choose, since ValuCare coverage applies to both hospital bills and professional fees.
• However, it’s best to use ValuCare coverage for professional fees, as the rates are pre-negotiated and fixed, and help you save on doctor charges.

Can I use two health cards or medical coverages for the same confinement?

No. Dual coverage is not allowed. You must choose one card or plan to use perconfinement.

Will ValuCare cover skin grafting if it’s part of my treatment?

Yes, if the procedure is medically necessary as determined by your accrediteddoctor and is not excluded under the program. Coverage is subject to yourplan’s rules and the diagnosis.

If vaccination is the only treatment in an emergency (e.g., snake bites or anti-rabies), will ValuCare cover it? Does the exclusion only apply to preventive vaccines?

● ValuCare’s Exclusions & Limitations state that vaccines, screening tests, allergy tests, andrelated treatment materials are generally not covered.
● Emergency vaccines (e.g., anti-venom, anti-rabies) are covered only if included in your plan.
● If the vaccine is not part of the plan, ValuCare will not pay for it, even in emergency cases—only the administration fee may be covered.

If I was misinformed about the reimbursement process by an accredited doctor’s office, who is responsible?

● ValuCare is the authoritative source for accurateinformation on reimbursement procedures and memberprograms.
● Accredited doctors and plan coordinators are primarilyresponsible for providing healthcare, not internal ValuCareprocedures.
● ValuCare will not be liable for misinformation fromaccredited providers or any third parties not employed byValuCare.
● Under our General Exclusions & Limitations, ValuCare isnot responsible for delays or service issues caused byevents beyond its control (e.g., government orders,natural disasters, strikes, or war), but will still do its best toprovide care.

If my ER visit results in an incomplete diagnosis and I need multiple hospital visits, do I have to pay until a diagnosis is made?

● ValuCare covers cases based on the diagnosis provided by an accredited doctor. If nodiagnosis is established, the case is not covered.
● Once a diagnosis is confirmed and the case is covered under your plan, you can file forreimbursement following ValuCare’s procedures.

Are there any limitations on X -RAY coverage?

Yes, X-ray costs are covered by your plan but are subject to your MaximumCoverage Benefit (MCB), pre-existing condition rules, and Exclusions &Limitations.

If a service isn’t clearly listed in the exclusions, can ValuCare reimburse me if I pay upfront?

ValuCare will reimburse emergency medical expenses you paid, as long as the service iscovered under your plan and not listed in the Exclusions & Limitations.

How do I appeal a previously declined claim, and is there a deadline?

● If a reimbursement claim is disapproved, ValuCare will send you a notice.

● You must submit a letter of appeal within 7 days of receiving the notice, including anysupporting documents.

● ValuCare will re-evaluate your appeal and respond within 15 working days.

● For regular reimbursement filing:

● Claims can now be submitted via the ValuCare SuperApp.

● Original documents must still be submitted within 30 days to ValuCare HQ,Meralco Ave., Ortigas (required for BIR compliance).

● Claims submitted after 30 days will not be honored.

What if the hospital requires cash payment for some procedures, even if recommended by an accredited doctor?

If an accredited hospital has a cash-basis policy for certain procedures, the member can:

● Pay for the procedure at the same hospital.
● Call ValuCare Customer Service at (02) 8702-3310 for endorsement to a nearby accreditedclinic or hospital that allows full HMO coverage.

Note: Hospital services are subject to the hospital’s rules (General Exclusions & Limitations,Article 6.6).

Who decides if a hospital visit is an emergency?

The attending doctor determines whether a case is an emergency.

Under ValuCare’s Health Service Agreement, an Emergency Condition is asudden, serious illness or injury that could cause immediate disability or deathsudden, serious illness or injury that could cause immediate disability or deathand

Do I need to pay for the professional fees of accredited Neurologists, EENT, and Urologists? What about recommended procedures?

● Call ValuCare’s 24/7 Customer Service at (02) 8702-3310 for assistance.
● Neurologists: Most in the Philippines do not accept HMO accreditation.ValuCare will, as much as possible, coordinate with partnered neurologists tohelp cover your case.
● EENT and Urologists: ValuCare has accredited specialists, and professional feesand recommended procedures under their care are covered by your plan.