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    Affidavit of Complaint Maxi

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    Francis Joshua Palmes Faraon
    Camilo N. Villanos files an affidavit of complaint against Maxicare regarding denied medical insurance payments totaling around 25,000 pesos. The affidavit details instances where Maxicare denied payment for blood tests, doctor consultations, and medical procedures despite Villanos having a fully paid Maxicare Prima Gold insurance card. Due to the denied payments and insufficient services, Villanos suffered stress and almost had a second heart attack. The affidavit is being filed to seek reimbursement from Maxicare for the denied medical expenses.

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    Affidavit of Complaint Maxi

    Uploaded by

    Francis Joshua Palmes Faraon
    40 views1 page
    Camilo N. Villanos files an affidavit of complaint against Maxicare regarding denied medical insurance payments totaling around 25,000 pesos. The affidavit details instances where Maxicare denied payment for blood tests, doctor consultations, and medical procedures despite Villanos having a fully paid Maxicare Prima Gold insurance card. Due to the denied payments and insufficient services, Villanos suffered stress and almost had a second heart attack. The affidavit is being filed to seek reimbursement from Maxicare for the denied medical expenses.

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    Camilo N. Villanos files an affidavit of complaint against Maxicare regarding denied medical insurance payments totaling around 25,000 pesos. The affidavit details instances where Maxicare denied payment for blood tests, doctor consultations, and medical procedures despite Villanos having a fully paid Maxicare Prima Gold insurance card. Due to the denied payments and insufficient services, Villanos suffered stress and almost had a second heart attack. The affidavit is being filed to seek reimbursement from Maxicare for the denied medical expenses.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    40 views1 page

    Affidavit of Complaint Maxi

    Uploaded by

    Francis Joshua Palmes Faraon
    Camilo N. Villanos files an affidavit of complaint against Maxicare regarding denied medical insurance payments totaling around 25,000 pesos. The affidavit details instances where Maxicare denied payment for blood tests, doctor consultations, and medical procedures despite Villanos having a fully paid Maxicare Prima Gold insurance card. Due to the denied payments and insufficient services, Villanos suffered stress and almost had a second heart attack. The affidavit is being filed to seek reimbursement from Maxicare for the denied medical expenses.

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    © All Rights Reserved
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    AFFIDAVIT OF COMPLAINT

    KNOW ALL MEN BY THESE PRESENTS:

    That I, Camilo N, Villanos, of legal age, Filipino, separated and resident of 72 E Maginhawa St.,
    UP Village, Quezon City, after having sworn to in accordance with the laws of the Republic of the
    Philippines, hereby state the following;

    1. That I am a legitimate card MAXICARE Prima Gold No. 11580110 8353


    0603 fully paid under Maxicare OR no. 300087937;
    2. That as early as the year 2010 or later, more or less, I have been in
    consultation with Dr. Neil T. Gomez, MD,FPCP, FPCC of Phil. Heart
    Center and MAXICARE accredited medical practitioner regarding my
    health condition;
    3. That affiant first used the said Maxicare Prima Gold Card to Premiere
    Medical & Cardio Lab for Blood Chem/Test on March 12, 2020. But
    Maxicare denied payment for the said basic Blood Chem/Test. Thus, I paid
    cash for the said procedures, complete results of which were given &
    delivered at Dr. Neil T. Gome’s PHC clinic;
    4. Again, for the second time Maxicare denied payment for my Doctor’s
    consultation fee at PHC on March 14, 2020 (reason not covered);
    5. That on June 8, 2020 , I presented the same Maxicard at MyHeath Clinic
    SM North franchise for Blood Chem/Test, ECG, X-ray. 2D Echo w/
    Doppler and Doctor’s Consultation. This time Blood test & ECG were only
    processed. I was advised to proceed to MyHealth Clinic, Shangria franchise
    for X-ray and Consultation. 2D Echo procedure w/ Doppler is again was not
    covered by the Prima |Gold Card Likewise, Doctor’s fee was denied
    payment for the 3rd time.
    6. That on the same date, June 8, 2020 I suffered a lot of stress and almost got
    a 2nd heart attack for the insuficiency and unreliability of BOTH Maxicare
    and MyHealth Clinic. I started at 8am and ended at around 3pm without
    having a clinic for 2D echo with Doppler.
    7. That, this affidavit is being executed to attest to the truth of the foregoing
    statements of facts in order to secure redress on the Maxicare procedures
    and to get CASH refund on affiant expenses on Medical procedures denied
    by Maxicare Inc. amounting to more or less P25,000.00 including
    Attorney’s fees and other incidental expenses to this regard.

    Further, Affiant, say no more.

    IN WITNESS WHEREOF, I have hereunto set and affix my signature this ___th day of June,
    2020 at Quezon City, Philippines.

    CAMILO N. VILLANOS
    Affiant

    A CK N O W L E D G E M E N T

    REPUBLIC OF THE PHILIPPINES )


    QUEZON CITY . . . . . . . . . . . . . . . ) S.S.

    BEFORE ME, a Notary public for and in the City of Quezon City this ___th day of June, 2020
    personally appeared Camilo N. Villanos with CTC No. 00104451 issued in Quezon City, on January 02,
    2020 known to be the same person who attested to the foregoing statements.

    WITNESS MY HAND AND SEAL this ___th day of June, 2020, Quezon City, Philippines.

    NOTARY PUBLIC
    Until December 31, 2020

    Doc. No. _____;


    Page No. _____;
    Book No. _____;
    Series of 2020.

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