Philhealth Deduction Problem at Government Hospitals

 

There are lots of questions about Philhealth deduction at government hospitals,

and I cannot answer them all.

so I’ll try to give a common answer here that I hope can cover most questions:

First, you can no longer file your claim directly at a Philhealth branch.

You can no longer claim your refund from Philhealth after discharge.

There are only few exceptions, such as overseas confinement.

So, you must inquire about the hospital’s Philhealth processing upon admission,

and file your Philhealth papers with the hospital ASAP.

The correct processing is that your Philhealth benefit is fully DEDUCTED from your hospital bill, you pay the balance, and then you go home.

But the BIG PROBLEM with MOST GOVERNMENT HOSPITALS is that they DO NOT HAVE ENOUGH SUPPLIES and MEDICINES.

So what they do is give you prescriptions and then YOU BUY medicines and supplies from drugstores outside the hospital.

When you see your hospital bill, you will see your Philhealth deduction. Usually, there’s a balance that you need to pay.

In some cases, everything is paid for by Philhealth, and you will not pay anything.

How about the medicines and supplies you bought outside the hospital? There are times the amount is even bigger than your hospital bill?

How will you refund the money?

Or can you still refund the money?

You can refund the money or some of the money from the hospital

after several months

only if Philhealth will pay the hospital more than what was deducted from your hospital bill.

You can see this amount when you receive your BENEFIT PAYMENT NOTICE (BPN) from Philhealth after several months.

Or you can ask the hospital.

Or if you know the diagnosis or treatment, you can check Case Rate lists at philhealth.gov.ph or other health sites.

 

Example 1:

Diagnosis is Pneumonia (Moderate Risk).

The Philhealth benefit for this is 15,000 pesos

(10,500 pesos for hospital expenses, medicines and supplies and 4,500 pesos for doctors’ fees).

You bought 3,000 pesos worth of medicines and supplies outside the hospital.

Your hospital bill is 7,000 pesos. You were not asked to pay anything…because the 10,500 allocation is more than enough to pay this 7,000 pesos.

How about the 3,000 pesos you spent?

You still have available allocation (10,500 pesos – 7,000 pesos = 3,500 pesos).

Keep your prescriptions, ORs,  and your hospital bill, and when you receive your BPN, return to the hospital and request for your refund.

ORs must be in the name of the patient. Xerox your documents.

 

Example 2:

Procedure done is Cesarean Section (CS).

Philhealth benefit for CS is 19,000 pesos

(11,400 pesos for hospital costs and 7,600 pesos for doctors’ fees)

You bought 9,000 pesos worth of supplies and medicines outside the hospital.

Your hospital bill is 14,400 pesos. You paid 3,000 pesos (14,400 pesos – 11,400 pesos = 3,000 pesos).

What about the 9,000 pesos you spent?

Sad to say, the allocation of 11,400 pesos has been fully used up.  So you can no longer refund your 9,000 pesos.

12 Comments

  1. sey November 6, 2014
    • Nora November 9, 2014
  2. karen lorzano January 4, 2015
    • Nora January 5, 2015
  3. dhes January 5, 2015
    • Nora January 5, 2015
  4. Rena February 10, 2015
    • Nora February 10, 2015
  5. Rose March 16, 2015
    • Nora March 21, 2015
  6. basilisa November 19, 2015
    • Nora November 19, 2015

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