How to File a Claim for Philhealth Reimbursement or Refund
Ang individual filing of a claim for Philhealth reimbursement or refund ay dapat iwasan, kasi matagal mag-antay ng refund, lalo na ngayon na marami nang Philhealth claims na prina-process.
Over the past year, maraming nagco-comment dito na 5 months or 7 months na ay wala pa ang kanilang refund. So gawin ninyo lahat ang makakaya nio to submit all the needed documents before discharge, para ma-deduct na agad sa hospital bill ang inyong Philhealth benefit.
In cases na wala talagang magawa, dahil mag-isa ka lang, at walang mag-asikaso ng papel dahil hindi puedeng iwanan ang pasyente, at walang ibang puedeng magbantay o kumuha ng mga needed documents, yan ang valid reason na hindi nga ma-submit ang Philhealth requirements before discharge.
In that case, ito ang mga steps to file a claim after hospital discharge:
1. Collect or accomplish the following documents:
- Philhealth Claim Form 1 (filled-up and signed by you, and your employer if you’re employed)
- Philhealth Claim Form 2 (filled-up and signed by the hospital and your doctors)
- Philhealth Claim Form 3 (filled up and signed by the hospital and your doctors)
Claim Form 3 is required for the following cases:
– If treated in a Level 1 hospital
– If it’s a maternity case
– If confinement is less than 24 hours
– If transferred due to emergency
– If condition is Case Type D
- Clear copy of Member Data Record (MDR) (Get this from Philhealth)
- Receipts of Philhealth premium payments (receipts for at least the required number of months)
- Original Official Receipts of Payments Made to the Hospital
- Hospital and doctor’s waiver (if there are no official receipts)
- Operative record (if surgery was performed)
- Proof of dependency (marriage certificate or birth certificate) kung dependent ang pasyente at hindi pa nakasulat ang name sa MDR as dependent
- Note: Para sure na ma-issue sa inyo ang check, in addition to the ORs, submit also the hospital bill and waiver from the hospital and doctor. Keep copies for yourself. Itong note na ito ay based sa mga comments ng mga nagre-reklamo dito sa mga blogs namin.
2. I-submit ang mga documents diretso sa Philhealth o sa hospital.
Kung maibigay ng hospital lahat ng documents na dapat manggaling sa kanila, kayo na ang magdiretsong mag-submit sa any Philhealth branch. Pero, usually ipapasubmit nila ang mga documents na dapat manggaling sa iyo, tapos sila na ang magsa-submit.
3. Make sure to submit the required documents ASAP.
You only have 60 calendar days after discharge to submit your Philhealth claim (counted ang weekends at holidays).
4. After making sure na na-file na with Philhealth, I suggest na kalimutan mo muna ng mga ilang buwan yong claim. Huwag mainis, kasi mai-stress ka lang, masisira lang ang araw mo.
5. After 4 to 5 months, you can make a follow-up by calling the Philhealth call center: 441-7442
5. After months of processing, you will receive a mailed or courier-delivered Benefit Payment Notice (BPN) from Philhealth. Philhealth will mail the benefit notice to the address you wrote in your claim form.
NOTE: Merong additional required documents for confinements abroad.