PhilHealth members worried over full billing by private hospitals

May. 22, 2014

TAGUM CITY – Residents here have started publicly airing their worry over the plan of private hospitals to bill in full the patients’ hospital expenses leaving the patients to collect by themselves the reimbursements from the office of the Philippine Health Insurance Commission (PhilHealth).Residents interviewed by Davao Today were worried that this move of private hospitals would turn into “another wave of financial burden.

“Nganong kami man paantuson sa mga ospital if wala sila nabayran sa Philhealth. Dili man namo ni sala! Ug isa pa kining benepisyo namo nabayran naman namo sa Philhealth. Dili pud siguro patas na kami mubayad sa sala na dili namo binuhatan (Why put pressure on us if they were not paid by PhilHealth. It’s not our fault. And one more, we already paid for these benefits,” Christopher Lenadro, a PhilHealth member, told DavaoToday in an interview.

“Dili nila unta hatagan ug problema ang mga Philhealth members kay religiously they are paying their premiums every month. Unsa naman lang pulos kung ingon ana na ang sistema? Asa naman diay niadto ang ginabayad na contributions namo? Asa man ang hustisya ana? (They should not give us problem because we are paying religiously our premiums every month. What’s its use if this would be the system now? Where did our contribution go? Where’s justice here?),” asked Lenadro.

Lenadro blamed PhilHealth officials for “poor and incompetent management”. “Kining mga nagdumala sa PhilHealth kung dili “tanga”, mga “bala”. Unta ilang gisiguro na mahatagan ug tarong na serbisyo ang mga miyembro. Kung maayo sila na tigdumala wala kini mahitabo. Kadako sa pundo sa Philhealth, tapos ingon ani pa ang mahitabo (These PhilHealth officers, if not stupid, are inept. They should have ensured adequate service. If they are efficient, this should not have happened. It has a big savings but this happened.)”

Other PhilHealth members have viewed it as a “deliberate act to strip off their healthcare benefits.”

Benjamin Origin said “(C)learly the move of private hospitals is a serious attempt to take away of our hospital benefits,” adding that “if pursued, it will earn opposition from the PhilHealth members.”

Origin, who is also a diabetic patient, noted that “some private hospitals don’t even offer standard facilities and services to PhilHealth members.”

“Aside from our usual plight of paying expensive bills, hospitals must upgrade also their facilities and services. We pay correctly, so I think we deserve no less better facitities and services,” Origin said.

On Monday, the Private Hospitals Association of the Philippines, Inc. (PHAPI) said its member-hospitals will enforce a new system of payment of medical bills for PhilHealth members next week by “accepting PhilHealth patients but will not remove the PhilHealth part (of their bill).”

“These patients can then go to PhilHealth themselves to get the bills reimbursed and patients must then directly file their claims with the PhilHealth,” Dr. Rustico Jimenez, PHAPI President was quoted in the media reports as saying.

PHAPI claimed that payments of PhilHealth to some of PHAPI member-hospitals were delayed already for six months, forcing these hospitals to stop accepting PhilHealth patients.

Sought for comment, Philippine Health Insurance Corporation (PhilHealth) said in an email sent to DavaoToday that the delay of payments was due to the new payment system being implemented by the agency.

“(P)lease be clarified that the perceived delays in the payment of claims of PHAPI member-hospitals are part of the technical challenges and birth pains PhilHealth is currently experiencing as a result of the full implementation of the case-based payment system in January of this year,” PhilHealth President and CEO Alexander Padilla said.

Padilla said that PHAPI member-hospitals will be violating the Performance Commitment which the member-hospitals of the PHAPI have executed with PhilHealth should in case PHAPI will pursue its plan of not honoring the hospital benefits of PhilHealth patients.

Lifted in Section 14, from a sample document of Performance Commitment obtained by DavaoToday, states that hospitals “shall provide and charge to the PhilHealth benefit of the client the necessary services including but not limited to drugs, medicines, supplies, devices and diagnostic and treatment procedures for (their) PhilHealth clients.”

Johanna Blason, Public Relations Officer of PhilHealth in Davao region, told DavaoToday “there are sanctions that can be imposed on these hospitals, PhilHealth would want that services to its members remain uninterrupted, and that the matter be settled soon without depriving members of the benefits due them.”

In Region XI, there are 44 member-hospitals under Private Hospitals Association of the Philippines, Inc. (PHAPI) with 11 hospitals from Davao del Norte, 14 from Davao del Sur, 15 from Davao City, 4 from Panabo City and 1 from Compostella Valley province.

These private hospitals are categorized as primary and secondary hospitals.

Meanwhile, Anak Pawis party-list representative Fernando Hicap blames Philhealth President Alex Padilla by letting the situation worst. This despite the fact that Philhealth has sufficient funds to cover the hospital bills of its members.

“This is not some simple mismanagement, it’s incompetency at its finest, where are the millions of pesos fund of Philhealth, why Mr. Padilla failed to pay on time the hospital bill of sick members?” Hicap said.

Anakpawis disagrees with the Private Hospital Association of the Philippines [PHAPI] action to force its patients to shell out more money to pay their bills.

“It should not in any way hostage its patients because of Philhealth’s delay of payment. PHAPI should continue honoring the Philhealth of the its patients, they are not the ones who created the financial mess in the first place, its Mr. Alex Padilla’s action,” the group said in a statement.

“It is really unjust that while Philhealth members paid their dues in order to secure health benefits in times of emergency, Mr. Padilla on the other hand are not giving the same commitment” Hicap added. (

comments powered by Disqus