HMO Information
Let us help you access and maximize your health insurance benefits
Finance / HMO Office
The HMO Office at Pampanga Medical Specialist Hospital helps patients access the benefits included in their health plan. Our dedicated staff coordinates with HMO providers to ensure smooth verification, authorization, and billing — so you can focus on your health, not the paperwork.
Services Offered
- Membership verification
- Benefit verification
- Letter of Authorization (LOA) processing
- Admission assistance
- Billing coordination
- Coordination with accredited doctors
Procedures
- Verifying membership and eligibility
- Checking benefits and coverage
- Issuing or processing of Letter of Authorization
- Coordinating hospital admission
- Processing direct billing and claims
- Assisting with referrals and patient inquiries
What to Expect
Courteous and respectful staff who communicate professionally.
Clear explanations about HMO benefits, coverage, exclusions, and requirements.
Accurate processing of membership verification and Letter of Authorization.
Timely approval of eligible consultations, tests, procedures, and hospital admissions.
Knowledgeable personnel who can answer questions and resolve concerns.
Fair and transparent billing, including clear information about any out-of-pocket costs.
Technology & Equipment
Hospital Information System (Medsys System)
Insurance online authorization portal
Computer and secure internet connection
Desktop
Printer and scanner
Telephone and cellphones
Assigned Physician
Dr. Alvin Rene R. Susi
Monday, Wednesday & Friday · 1:00 PM – 5:00 PM
Frequently Asked Questions
How do I use my HMO card?
If it's your first time using your HMO card at our hospital, the usual steps are:
- 1Bring your HMO card, a valid ID, and any medical records or referral.
- 2Go to the HMO Office and present your HMO card for verification.
- 3Schedule an appointment with an accredited doctor.
- 4Request approval from the HMO Office for a Letter of Authorization (LOA).
- 5Bring the LOA and your HMO card on the date of your consultation.
Are all hospital services covered?
Not all hospital services are automatically covered by your HMO card. Coverage depends on your specific HMO plan, benefit limits, medical necessity, and the terms and conditions of your HMO plan.
Which doctors are accredited by my HMO?
You may check our list of accredited doctors through our official website or by requesting a printed copy available at our HMO Office.
How long does Letter of Authorization processing take?
Approval time depends on the type of request, completeness of requirements, and the insurance provider's processing guidelines. Our staff will assist in following up on your request.
What are the coverage limits of my plan?
Your coverage limits depend on the specific HMO plan you're enrolled in. To check your exact limits, we'll need to verify your HMO membership details and review your plan benefits. We can also explain any remaining balance, exclusions, or services that require prior authorization.
Are surgeries and hospital admissions covered?
Surgeries and hospital admissions may be covered by your HMO plan, but coverage depends on your specific benefits, medical condition, the type of procedure, the hospital or doctor's accreditation, and your plan's coverage limits.
Contact & Appointment
Department Head
Majeleine B. Kim
Person to Contact
Sarah P. Medina
Ground Floor, New Building Entrance, HMO Office, San Antonio, Guagua, Pampanga 2003 Philippines