Monday, June 2, 2014

Another Funny Thing Filipino Women Need to Know About Their Clever SSS




FILIPINO women living or working in Makati need not know anything more about either how rude that medical-benefit-claim-form lady assessor/clerk at the Social Security System Makati Office is or particularly how she impatiently treats everyone who approaches her desk like the teacher’s most-dreaded stupid pupil come again to ask another stupid question, bless her cursed soul. Should you have the misfortune of needing to claim a medical benefit, your day is sure to get ruined seeing her and her ways, to be saved only by the niceness of the SSS doctor over at desk 2. Oh, no need to tell this, really, because, after all, 99% of us already have ample understanding of how deep the shortage is in government service of people with people skills.
     In fact, just a few days ago, I was at the National Statistics Office at East Avenue in Quezon City to witness a security guard, not a regular staff but a security guard, directing the citizens falling in line in the hall with instructions coursed through a megaphone that went like, “Ano ba naman kayo? Ang nandito sa pila na ‘to ay yung buntis na, hindi yung magpapabuntis pa lang. Yung wala pang form, dun muna ninyo gawin sa kabilang pila, ha. Magpabuntis muna kayo roon!” Witty with a drunkard’s metaphors and humor, eh? But decidedly inappropriate humor in a government service institution, my sir, wouldn’t you agree?
     A rarity, perhaps, then, would be an NSO records supervisor named Beth Galicad who called a peer on the phone to say, “meron tayong client dito na si Mr. …” Wow. While the unworthy security guard looked upon his fellow citizens falling in line outside as the unintelligent mass burden of our republic (not as the very taxpayers paying his salary), Ms. Galicad regarded me, an ordinary citizen with a lost record, as a “client.” How cool is that?

NOPE. This is not to enumerate further shortcomings and personnel shortchanges in government service institutions, for—like I said—I’m sure everyone has his own long list and book of anecdotes that regularly tell us to feel sorry about our wages’ tax deductions every fifteen days, never mind feeling sorry for our country continually being governed by the political elite un-eager to rid us of our feudal culture composed of lordly landlords on this side and ordinary citizens in beggary being lorded over by the landlords servants (civil servants, mostly) on that side.
     Instead, this essay is really just seeking to follow up on my wife’s wish for ample information on something that perhaps my blog site could accommodate, which I did promptly offer, information specifically addressed to other Filipino women who might benefit from the knowledge about that medical benefit called “disability”; not so we can sour-grape on her disqualification with her claim, but so we can spread the very knowledge, believe me or not, the knowledge—by the way—the SSS says certainly cannot be on their website as “not everything is there” and “we really don’t put everything there.” [Well, yes, of course, the appropriate answer might perhaps be “we will inform our website managers to put that detail online,” but, c’mon, appropriateness, people—as we probably all know by now—, is not a priority in government service. Well, perhaps not until we get rid of an elite-leaning culture that might then veer away from looking at service institutions as just some people’s milking cows, moving on towards looking at them as truly service institutions. After all, whatever happened to the Marxist influence on the social security concept? Aha! The answer to that question might be obvious to some of us who see everything happening in government as an illness needing a cure, or a corrupt file needing a fix, though often accepted as a sorry state by most who’ve given up on the possibility of seeing any fix. No appropriate line to be expected by the ears, then, no worthy assessor on that many a clerk’s desk, no appropriate answers to very specific questions, except for a rarity that one may be lucky to meet in his lifetime under any Philippine government’s color-coded sun.]

THE simple information my wife really just wanted added to the SSS website was this: … well, okay, maybe I ought to offer a backgrounder first.
     You see, my wife just had a TAH-BSO, or Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy. And, in case you don’t know yet, a TAH-BSO qualifies an SSS member to a disability benefit. Many a woman member has, in fact, received an SSS disability pension even from a simple hysterectomy.
     The inclusion of these operations as disabilities in the SSS’ new disability benefits program is culled from the World Health Organization’s expanded definition of disability, viz., as any “restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.” According to the SSS, impairment has been further defined by the WHO as any loss or abnormality of psychological, physiological, or anatomical structure or function. Take note of that!
     The aim of the new disability benefits program, says the SSS, is purportedly “to ensure that the right cash benefit for disability is paid to truly deserving members.” And who would be those truly deserving? Supposedly, it adopts the International Statistical Classifications of Diseases and Related Health problems Codes (ICD-10) [check out that list here: http://apps.who.int/classifications/icd10/browse/2010/en].

     The SSS further says that the member with 20% medical impairment is already qualified for functional assessment. Some of the permanent partial disabilities include loss of one thumb, or one index finger, or one middle finger, or one ring finger, or one little finger, or one big toe, among a number more in the list. Meanwhile, apart from complete loss of sight of both eyes and such similarly permanent total disabilities, some cases may actually be classified as belonging to this latter category by the determination and approval of the SSS. Well, those determinations may remain privy to no one other than those who make them, as the SSS does not—cannot—prefer not to?—put everything on its website.
           
AND so now we go back to the TAH-BSO, or the simple hysterectomy, for that matter, both of which, by the way, cannot be categorized with losing a pinky, for all intents and purposes.
     What, according to the SSS, would disqualify one from claiming medical benefits after undergoing one of these above operations?
     Well, guess what. Age, that’s what! The SSS has determined, by some law I have yet to see, that only members 44 years old and below can avail of the benefit by one of those –tomies. [We did not ask if one can claim a disability benefit from losing a pinky at age 46]. The SSS law I have yet to see supposedly has this rationale or interpretation of the WHO expanded definition: we at the SSS believe, or that law you have yet to read believes, that the WHO’s definition is implying the fact that women who have undergone one of those above –tomies cannot anymore bear children. By that inability, the inability to bear children, we have accepted the inclusion of these –tomies as resulting in a disability. The age limitation was arrived at allegedly after talking to a majority of OB-Gyns regarding the average birthing age of women. [I didn’t ask if the SSS ever asked surgeons about the average age of typists who cannot afford to lose their pinky—can they still lose it at age 46 and claim benefits?] Never mind, too, that the SSS might accept the fact that there have been a number of women in their 50s who have had their menopause delayed and had babies at that age period, but the law is the law, the SSS says, talking like a lawyer instead of a medical-benefits provider, except for the fact that it couldn’t give us the Republic Act number of that law we have yet to see.
     Never mind, likewise, the fact that many doctors who advise a hysterectomy procedure with additional ovarian removal ask for the patient’s approval first, and once the approval is gained often advise the patient in turn to keep one of the ovaries if “possible”. True, some doctors, especially oncologists looking at a patient with a family history of oncologic cases, may advise a drastic TAH-BSO as an option for a mere case of adenomyosis, as for instance if the patient does not have the financial capacity to get a later oophorectomy should that be needed in the future.
     The reason for this is really simple, which simplicity may have escaped the SSS and some legislators. (But not so simple if you’d be seeking an opinion on ovary function from the SSS doctor based in SSS Meycauyan, which opinion would really be hard to come by, the doctor being hard to catch—the SSS Meycauayan assessor agrees that one simply has to get a continuing leave of absence from one’s work to gamble on catching the doctor at his/her SSS Meycauayan room. Simpler, it would have been, if the first clerk already had knowledge of the fact that you can actually “file anywhere”; complex it is for members to fall in line with others seeking a conference with the branch manager just to get that simple information.)
     The simple reason why many doctors try not to remove both ovaries, as much as “possible,” is because the ovary is not just for producing eggs. In fact, the loss of both ovaries renders a woman at high risk of getting any one of the cardiovascular diseases as well as bone diseases. And while the ovaries are not the sole sources of estrogen, they are the prime sources of it, and you might have an idea of what may happen to a woman when her supply of estrogen is drastically diminished, albeit loss of ovaries does not have a uniform effect on all women. If you were a doctor not constrained by (subjective? interpretative?) SSS rulings, you would definitely know that the loss of both ovaries is already a great “restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.” Likewise, that it is already “loss or abnormality of psychological, physiological, or anatomical structure or function.” Go ahead and google it. Better yet, get more information about ovary function from your OB-Gyn, beyond just asking about the average age of women birthing. Conversely, don’t try to get more information on it from an SSS doctor constrained by a simple-headed law that I have yet to see.
     Oh, by the way, we ought to thank that oft-referenced law for supposedly enabling the WHO’s expanded definition of disability for SSS’ use, although I’d have to laugh that that same law virtually put limitations (almost as a sort of counter-measure) on the WHO expansion. Isn’t it funny? An expansion tries to expand, and its enabler tries to limit it. Isn’t it funny? Or should I say, aren’t we a clever people?
     After all, I found out at waiting areas that it’s not just me who’s been wondering why the SSS has placed all its friendly faces in Payment and some of its rude ones at Claims. So much for that Marxist influence on the social security concept. [X]



16 comments:

  1. Hi Mr. Soria.

    I have the same case as your wife. I recently had TAH-BSO operation and pathologically I was found to have cancer.

    I wonder if you were able to claim for your wife's disability benefit. If that age thing matters, I guess I'm more than NOT qualified as I'm already in my 50s. If you were able to claim, on what grounds you were able to? I'm asking so I can make a pattern to my case. My hospitalization bills is so high and I'm recommended by my doctor for extended treatment such as chem and radiation. I just hope that at least I can get something from SSS. I'm not employed but I'm a voluntary member.

    Please share your experience. Thank you.

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    1. Hi, Endien. My wife was unable to get anything, because it seems that SSS' definition of a disability benefit in relation to women who've undergone reproductive area operations is limited to a compensation for being unable to reproduce anymore when you're at an age that can still reproduce. Therefore, if you lose your entire reproductive system at work, you won't get any benefits if you're above 44 because---again---the package is solely to comfort those who cannot bear children anymore at that age when they still can. If a woman loses her entire reproductive system at an age where "she's not supposed to be bearing children anymore", the SSS won't give a fart about her anymore. The SSS, it seems, don't have a benefit package to comfort women in that zone, so to speak.

      I have not seen that law the assessors were talking about which they could not even tell my wife the RA # of, but somebody in Congress ought to rewrite it.

      I'm sorry to hear about your hospital bills, Endien.

      My prayers for you for your complete healing.

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    2. Same thing happened to me, i was asked by SSS Cubao EDSA for personal appearance & i went there July 22, 2016 to be inforrmed i am ineligible for disability claim since i was 46yrs old when (TAH) total abdominal hysterectomy was performed.

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    1. Mr de Veyra,

      I had hysterectomy last May 2016 & was informed by a friend to file SSS disability claim.
      I received a check for 10,080.00 representing 21days x P480 & went back to SSS cubao to file for disability. My office staff requested for the Disablity Form & doctor on duty required my personal appearance so i rushed to the branch and i handed the forms to clerk on counter 12. I was so disappointed when the clerk informed me that I am not eligible for Disability Claim bec the age limit is 45!
      I questioned the clerk where is the law/ resolution for this & she went to look for an old file and showed me a handwritten exclusion: 45 yrs & above not eligible.
      She consoled me by saying you will receive your pension on old age...
      I was furious, i told them they should have checked the records before asking anybody for personal appearance, my medical certificate clearly stated 46yrtas of age! I wasted my day for nothing

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    2. SSS should re-visit their rules, laws, requirements, etc. And that they should practice transparency. For sure, a lot of women doesn't know about this disability ruling.

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  3. Hi, undergone TAHBSO Jan 31,2017. My employer processed my SSS paper. To date I still waiting for feedback, am I qualified?, I be 46 by end of June 2017. zynab

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    Replies
    1. Unfortunately, Ann, hindi na raw. As per the report of Julie Yap (see her comments above), 45 above disqualified na raw.

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  4. Hello po, I just had Hysterectomy two weeks ago. i'm 35 years old going 36 this August still employed but on leave for 2 months through SSS Sickness Benefit kasi ubos na na Paid SL ko sa company. Applicable po ba skin yung SSS Disability kasi po sabi nung SSS staff makaka avail lang ako if d na raw ako pwedeng mag work. alin po ba ang pwede at d pwede? thanks.

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    1. There is nothing in the SSS disability benefit's qualifying conditions that says that. The staff was wrong.

      https://www.sss.gov.ph/sss/appmanager/pages.jsp?page=disabilityqualifying

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  5. had TAHBSO in aug 12, 2017. i'm 45 yrs old. and NO i didn't qualify for disability benefit

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  6. Hi i underwent tahbso last aug16 2017 and they did not accept my application for dusability benefit due to age. I am 45 years of age. The rule prescribing an age limit is based on a board resolution approved in june 1964. I got a copy from sss which by the way has no signature page by directors that approved it. i plan to formally complain on this sa malacanang.

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  7. If you download the DISABILITY BENEFIT section in the SSS website, there is listed in the ILLNESS row "REMOVAL OF ORGAN" which qualifies for DISABILITY BENEFIT.

    Is it not TAHBSO operation removes an organ in the human body. if so, then it can certainly qualify for DISABILITY BENEFIT.

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    Replies
    1. Unfortunately, Anonymous, that website section does not mention the ineligibility of women aged 45 above, which has been this blog's very beef with the SSS.

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  8. Hi! i also underwent TAH(Total Abdomj al Hysterectomy) just last October 15, 2017. I am 36 y.o. but SSS also did not accept my application for dusability benefit because accdg to the sss staff I should have consumed first the 120 days leave for this year before I could avail the disability benefit. I haven't read any rulings regarding this one. Anyone knowledgeable with this?Thank you!

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    1. What? What do leaves have anything to do with disability benefits? Disability benefits cannot be reduced by some number of leaves, so I believe the staff was horrifyingly wrong. UNless that's another SSS secret ruling, in which case the (subjective?) ruling should be the object of our horror and blame.

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