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  • Philhealth Cares Report: Philippine Health Insurance Corporation

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    Richard Sonsing
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    1) Membership renewal for sponsored members is challenging due to requirements from provincial capitals and financial constraints faced by informal economy workers. 2) Individually paying members cannot avail benefits when they do not continuously pay contributions, due to a lack of information on requirements. Official receipts from banks also have issues. 3) Hospitals violate PhilHealth policies like requiring unnecessary documents, not implementing no balance billing, and not providing senior citizen discounts.

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    5 March Report (Final)

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    1) Membership renewal for sponsored members is challenging due to requirements from provincial capitals and financial constraints faced by informal economy workers. 2) Individually paying members cannot avail benefits when they do not continuously pay contributions, due to a lack of information on requirements. Official receipts from banks also have issues. 3) Hospitals violate PhilHealth policies like requiring unnecessary documents, not implementing no balance billing, and not providing senior citizen discounts.

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    37 views3 pages

    Philhealth Cares Report: Philippine Health Insurance Corporation

    Uploaded by

    Richard Sonsing
    1) Membership renewal for sponsored members is challenging due to requirements from provincial capitals and financial constraints faced by informal economy workers. 2) Individually paying members cannot avail benefits when they do not continuously pay contributions, due to a lack of information on requirements. Official receipts from banks also have issues. 3) Hospitals violate PhilHealth policies like requiring unnecessary documents, not implementing no balance billing, and not providing senior citizen discounts.

    Copyright:

    © All Rights Reserved
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    of 3

    Republic of the Philippines

    PHILIPPINE HEALTH INSURANCE CORPORATION


    Citystate Centre Building, 709 Shaw Blvd., Pasig City
    Healthline (02) 441-7444 www.philhealth.gov.ph

    PhilHealth CARES Report


    PhilHealth Regional Office: 5
    Month: March
    Issues and Concerns

    Membership

    Contribution

    Health Care
    Provider
    Relations

    1. NHTS-PR members are misguided whether they are being


    renewed as sponsored member in PhiHealth
    2. Sponsored members experience difficulty in renewing their
    membership because the provincial capitol is requiring a lot of
    documentary requirements.
    3. Sponsored Members whose membership had expired were
    discourage to continue their membership as member of the
    informal economy due to financial constraint. Also, according
    to them the cost of transportation is high thats why they
    opted to use it for buying medicines and supplies for their
    patient rather than using it for paying their premium.
    4. Sponsored members have a hard time in renewing their
    membership because their renewal is on hold due to the
    insufficient slots (2000 slots) under the provincial
    government.
    1. Due to lack of information with regards to mandatory
    conditions regarding benefit availment some individually
    paying members cannot avail their benefits in PhilHealth
    because they didnt continue paying their contribution.
    2. Official Receipts issued by banks/ACAs to the member do not
    reflect months and quarter paid or has a discrepancy.
    3. Some LBC branches receive premium contributions from
    PhilHealth members.
    1. Benefits for professional fee are charged as additional fee to
    members or it becomes on top of the amount paid cash to
    the healthcare provider. Estevez Memorial Hospital, Inc.
    2. Hospital requiring indigent members to present an updated
    MDR before they allowed to get medicine and supplies and
    undergo laboratory procedures. Sorsogon Medical Mission
    Group Hospital and Health Services Cooperative.
    3. Overpricing of medicines, supplies, professional fees and
    laboratories was observed in the hospital Sto Nino Hospital,
    Our Lady of Lourdes Hospital
    4. Hospital forcing members to sign a blank statement of
    account Camarines Norte Provincial Hospital, Labo District
    Hospital
    5. Unavalability of labs, drugs and supplies cause out of the
    pocket expenses of members. Rapu-rapu District Hospital.
    6. Hospital not automatically issuing statement of account, only

    Benefits

    Others

    upon the members request. Tachuling General Hospital Inc.


    7. Hospital requiring 6 months of contribution prior to
    confinement to avail of the benefits. - Gubat District Hospital
    8. Hospital have incomplete services for new born care package
    Leon D. Hernandez Memorial Hospital
    9. NHTS members/dependents were required to accomplish an
    affidavit of two disinterested person for a single or multiple
    letter discrepancies Pandan District Hospital, Caramoran
    Municipal Hospital
    1. Some member were not informed that their claims were
    denied/RTH.
    2. A lot of members are complaining of why is direct filing is not
    allowed anymore since some of them cannot comply with the
    requirements during confinement.
    3. According to BAS PRO V, proof of relationship or authorization
    and valid ID of the representative were required for signing of
    claim form 1 in the absence of the member.
    No Balance Billing:
    Hospitals that are not compliant with the NBB are as follows:
    1. Tanchuling General Hospital
    2. Pantao District Hospital
    3. San Jose Medicare Community Hospital
    4. Ocampo Municipal Hospital
    5. Tinambac Municipal Hospital
    6. Tinambac Medicare Community Hospital
    7. Ago General Hospital
    8. Manito Municipal Hospital
    9. Rapu Rapu District Hospital
    10.Labo District Hospital
    11.Masbate Provincial Hospital
    12.Ziga Memorial District Hospital
    13.Bato Maternity and Childrens Hospital
    14.Magallanes Medicare Community Hospital
    15.Viga District Hospital
    16.Prieto Diaz Municipal Hospital
    17.Juan M. Alberto Meemorial District Hospital
    18.Pantaleon G. Gotladera Memorial Hospital
    19.Matnog Medicare Community Hospital
    20.Dr. Fernando B. Duran Sr. Memorial Hospital
    21.Camarines Norte Provincial Hospital
    All Case Rates:
    1. Some Final Diagnosis or cases are non-compensable
    2. Basis in determining what will be the 1 st case rate or 2nd case
    rate has been difficul to some hospitals.
    3. Hospital clerks are still adjusting to the ACR policies, most of
    them find it difficult to look for the ICD Code of some
    diagnosis.
    Point of Care:
    1. Its not yet implemented in Camarines Norte Provincial
    Hospital, Josefina Belmonte Duran Memorial District Hospital,
    Dr. Fernando B. Duran Sr. memorial Hospital
    2. Bicol medical Center has a rule that those patient that are
    admitted 72 hours in their hospital are the only one eligible

    for Point of Care.

    Internal:
    1. In Albay Doctors Hospital the post area of CARES is the
    admitting section of patients with communicable disease.
    2. In Bicol Regional Training and Teaching Hospital CARES were
    temporarily refrain from doing IEC regarding dialysis until
    certain issues were clarified between the Hospital and PROs

    Commonly Violated PhilHeallth Circulars


    Observed Hospital Practice/s
    Requiring unnecessary supporting documents even if
    members already have updated MDRs with nothing to
    amend. Sto. Nino Hospital, Leon D. Hernandez
    Memorial Hospital, Our Lady of Lourdes Hospital, Labo
    District Hospital
    Not compliance with the NBB Policy
    Non-compliance with Senior Citizen discounts and VAT
    exemption - Sto. Nino Hospital, Leon D. Hernandez
    Memorial Hospital, Our Lady of Lourdes Hospital

    Circular/s
    No. 7, s-2007
    No. 1, s-2013

    No. 11, s-2011


    No. 22, s- 2012
    No. 56, s-2012

    Requiring the submission of certificate of No. 8, s 2007


    contribution/RF1 despite submission of a properly No. 50, s-2012
    accomplished and signed CF1 Sto. Nino Hospital
    Prepared by:
    Richard P. Sonsing
    PMT-CARES

    Noted by:

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