Why was my Philhealth Deduction for my Cesarean Section operation only 11,600 pesos? Philhealth says my Case Rate coverage should be 19,000 pesos.
The coverage amount of 19,000 pesos for Cesarean Section is further allocated as:
11,600 pesos for hospital cost
7,400 pesos for professional fee (PF) or doctor’s fee
The hospital should deduct 11,600 pesos from hospital expenses
and should deduct 7,600 from the fees of the ob-gyne and the anesthesiologist.
What usually happens is that only the 11,600 pesos is deducted from the total hospital bill,
based on many comments on our blogs.
There are various reasons, also based on comments on our blogs:
. The 7,600 coverage, when paid by Philhealth, will be given to the ob-gyne and/or the anesthesiologist as additional PF.
. The 7,600 coverage is in addition to the PF agreed upon with the ob-gyne before the CS operation. After all, the ob-gyne can quote any PF amount, as long as the patient agrees.
. 7,600 pesos is NOT CASH. It is to be paid by Philhealth months after filing. There might be reasons some doctors or hospitals do not deduct this 7,600 pesos from the bill.
. “It’s common practice” daw.
. The 7,600 pesos will be refunded when the hospital receives its reimbursement from Philhealth.
What you can do?
. When you receive your benefit payment notice (BPN) from Philhealth, go to the hospital with a copy of your bill, payment OR, BPN and ID and refund your 7,600 pesos.
. Ask to speak with the billing/collection/accounting manager or the head of the hospital.
. File a complaint with Philhealth. Bring supporting documents.
. File a complaint with DOH. Bring supporting documents.
. Write to newspapers, online news sites, etc. about your case.
. Write about your case on the Facebook page of Philhealth.
Or you can just consider your 7,600 pesos as a gift or token of appreciation.
If the hospital says they have given your 7,600 as additional professional fee to your ob-gyne and anesthesiologist, and you were given excellent care by them, then just think your 7,600 is your token of appreciation for their service, especially if the cash that you paid them is not that much compared to the professional fees charged by other doctors for CS.