when my father was hospitalized, i also had a bad experience with Phil health. i also expected that i can get the doctor fees since i already paid the doctors in full. But unfortunately, when i inquired from them, they told me that the check will be given to the doctors directly. so unfair! But inspite of that information, i send a letter requesting to get the doctor's fee (allocation) with the receipts as an attachment. The receipts indicated "PAID IN FULL"! but after a couple of months, a letter came telling me that they can't give me a refund. duh, whatever!

siu, i think i have to comment on this. PHIC will pay the doctor according to the difficulty of the cases he was performing to the patient. But it doesnt mean that the doctor will not ask for a professional pay from you aside from the one given by the PHIC. the PHIC rate is very much lower than the standard doctor’s PF . if the standard operation cost is 50t, PHIC usually pays only 1/3 of the standard, so 10t +++ ra. but it is the option of the MD not to charge his PF to you directly but instead only asks for the PHIC payment, this usually happens if the the MD is your friend or friend of a friend, or relatives of relatives. however, the PHIC check would come only after 6-7 mos after the operation has been perform, so quite unfair for us MD’s, we have also lives to live and mouths to feed. Another option would be to ask the MD if he can charge you according the PHIC rate only and not the standard rate plus the PHIC benefit payment that will very much later. so, win-win situation.

Hi doc tess, sorry for this very late response. This piece is not meant to indict the entire medical profession. I understand how the system works with philhealth and the doctors. I completely agree that the doctors should be paid what is due them. But what I also understand is that philhealth is meant to benefit the members. It is meant to ease the burden of medicine and hospital costs as well as the doctor’s fees. So if the doctor asks for 30k and the philhealth benefit is say 10k, then the member will only have to shoulder 20k, right? Precisely, when doctors know that you are a philhealth beneficiary, they normally adjust their doctor’s fees.

But this particular doctor charged his fee without considering the philhealth benefit. My cousin was charged with 30k. In other words, the actual PF is really 30k without philhealth. He did pay the entire amount, and when he learned later that he could avail of his philhealth benefits, he tried to ask the doctor if the latter could adjust his fees or in the alternative ask for a waiver so my cousin could collect the philhealth benefit. But the doctor declined. We learned that this doctor normally charged 30k as his fee. With the philhealth the doctor definitely got a bonus of around 10k on top of his 30k. With this kind of situation, I don’t see how a member could benefit from philhealth.

what a hotline! ughh….. i called to PHIC for many times to inquire about my membership but unfortunately theres no answering the phone.gosh! its so annoying, are the employees here really working? I hope that they can do their job properly coz they been paid for nothing! Shocks!!!!!

please!!!
I am a philhealth employee!!! it hurts me when i see comments like this!! I work hard because i believe in what Philhealth stands. If you encounter this problem again please try to tell usyour grievances either through calls or letter to your nearest philhealth offices. Im sure we act on them the soonest. or you can course it through me then i will be te one to make referrals for your problems. you can email me or ym arthur_lanuza@yahoo.com. but pls try first our official website www.philhealth.gov.ph good day!!!

Dr. Lanuza, now that you are aware of this situation, perhaps you could initiate a review on this policy regarding doctors’ fees. It appears this policy invariably allows abuses and defeats the very ends of what Philhealth, as you mentioned, stands to serve.

Dear sir/mam sui,

We do have policies on professional fees. It should be implemented based on the issued policy. For example, If a patient paid in full the hospital bill and professional fees. Its mandatory to all hospitals and accredited doctors to issue reciepts and sign the waiver forms so that the reimbursement checks will be sent to the patient/member indicatedin the claims!!! Probably, hospitals violated this provisions and can be held liable. This forms are readily available in all accredited hospitals!!!
God Bless po!!!

Oopps!!
I didnt realised po na this blog site is for attorneys/lawyers!!! Pasensiya na po if out of topic yata ako!!!

Thanks po ulit!!

doc art

these are one of the many instances na nakakawalang gana ang services natin, especially the ones made by the government.

Dr. Lanuza,

I also experienced the situation wherein the Prof’l Fee of the medical practitioner billed for the services rendered was without discount given to a PHIC covered patient. The system is like, he will bill the patient for an amount to a patient, then when the patient asks to deduct the corresponding PF supposedly to be paid/reimbursed by PHIC, the medical practitioner/doctor would claim that the amount he billed to the patient was already net of the amount supposedly shouldered by PHIC so no need to reduce further the bill, so what else can the patient do but pay the whole amount as billed, but the patient’s family later learned that the daily rate usually charged by that doctor is the same rate he billed the patient covered by PHIC, claiming PHIC counterpart was already deducted.

Sir, how can you at PHIC address this problem?

Dr. Lanuza,

Doc, this is just suggestion on how to correct what was presented here,

you have the list of PHIC accredited medical practitioners and posted in PHIC website, what about requiring them to give you the rate of their PFs, and publish their corresponding PFs so as to serve as advisory to PHIC covered patients how much they should pay them (only the net amount).

Dr. Lanuza,

I have tried the site you provided on ur post last June 13, 2008. It doesn’t work. Previous to this, I have googled the PhilHealth website service to check on my father’s membership record. The links don’t work too.

I guess nothing works right in any Philippine government service.

I will just have to caution my father about availing the PhilHealth privilege/s. As for me, I just have to forget about availing/subscribing any philippine government benefits (as how it’s ‘coined’). I don’t want to be screwed up more because of it, in one way or another.

I just talked to a Philhealth Rep on the phone a while ago since my granmother was just discharged from the hospital and we need to file the PhilHealth claims (my mother is the member). I was told that if we have the receipt of the doctor’s professional fee, we can just attached it to the claims we are going to file, and the check for all the claims will be issued to us including the doctor’s fee… hopefully that is true and that will work.

I am trying to relate this to the situation above. Dont you have the receipt? I might have missed some information, please let me know so I will know also what else to do.

Ardeeboi, unless there has been a new policy being enforced, you still need to ask a “waiver” from your doctor for you to get the check. Remember, checks are already in the doctors’ names.

To avoid problem with the billing, before getting the services of the doctor, you must clear the PF thing… will I be the one to re-imburse with Philhealth, or just deduct it? If you will be the one to re-imburse, please indicate with the doctor’s OR that the payment already charge to the member.

alexis, i think that’s the problem, not all patients know that. And philhealth does not appear to be doing anything to inform the members about that.

mystep mother was previously gone an operation in one hospital in Manila. My father is a member of Philhealth. Unfortunately the doctors fee has been paid separate and given directly to the doctor performed the opeation. I am just wondering why the doctors fee being paid for was not deducted in the total hospital bills charged and paid by us. The hospital said PF is not reimburseable thru philhealth only hospital bills. Is that correct sir? iam only asking if PF is not covered by Philhealth. Until now I am trying to contack Philhealth for our refund ( check was sent back to main office in Manila because they cannot find my father’s address) but until now Philhealth employee said they have to view first(I dont know what they are going to view first) They are crazy if the mailed check was return to the main office it will not take long to view (I cannot understand the logic behind this kind of attitude of some of our government employee) They have to verify only if the check was already there or not. They advise me to call and make followup everyday. VERY POOR PERFORMANCE we have some employees like this. It will take a month to view the check?whether they received or not very ridiculous isn’t?

On the philheatlth benefit notice that was mailed to me it shows that there was no Philhealth benefit. (0MB - BENEFITS/ACTUAL CHARGES NOT ACCOMPLISHED). This may be because we did the Direct Settlement with the Doctor? Could I still ask Philhealth for a refund?

Are all philhealth employees stupid or too lazy to read the forms that were being submitted to them? My help went to philhealth office here at Quirino Ave, Manila to claim my ID on my behalf, these were all filled up by my employer and an authorization letter from me, to my surprise they (the philhealth’s stupid clerk i think) gave my help an M1c form - meaning this form should be filled up for non-paying members, I was furious when I saw the form the ask the help if they bother to read the attachments she said no, the clerk just handed her the form and asked me to fill it up without going through the attachments. STUPID PHILHEALTH

I really don’t have a problem with Philhealth. Compared to SSS, getting paid by Philhealth is a breeze and easy as hell.

The problem I think stems from doctors who refuse to make their earnings be known thus refusing to sign a waiver or even placing their doctors fee in the philhealth form when we claim philhealth benefits. I’ve encountered several doctors like that, one of the last i’ve had an agrument was with an anesthesiologist who upped his fee if I was to ask a receipt.

For the amount I am paying for Philhealth, it is really worth it in terms of what I am getting back from them. If your benefits aren’t deducted by the hospital when you check out, you can still file them after in there offices and per experience I’ve never encountered them not paying ever. Just give them time to send the check to you.

SSS though is another story, I don’t know why the SSS office here in Cebu is so hard to talk to with. You pay a big amount every month and yet get nothing in return. Jeezzzz

Dr.Lanuza ako po ay nakatangap ng cheque mula s philhealth,gawa po ng pagka2hospital ng anak ko.nakapangalan po sa aking asawa na ngayon po e nasa doha qatar.ang problema po hindi ko po sya main-cash dahil wla po kming bangko pra ideposit,ang cheque po ay nasa pangalan ng landbank.ano po ba ang dapat pong gawin pra po makuha ang pera,maliit na halaga lng po,1,193 pero malaking tulong po pra sa amin.sana po matulungan nyo ako

Pardon me but I could not help to conclude that these doctors are a greedy lot. I had my own experience with them. When my wife gave birth, I had processed her Philhealth claim. But since upon her check out her Member’s Data Record (MDR) was not yet available, we had to FULLY PAY the hospital charges, including the doctors’ PF, with the advice from the hospital that we can still claim from Philhealth for what we had paid for. When we went to Philhealth to claim for the s’ PF, we were advised to get a WAIVER from the doctors concerned. Considering that we FULLY PAID them when we checked out, we were confident that we would have no problem obtaining the waiver. Unfortunately, when we went to the doctors for their signature on the waiver, we were turned down, allegedly because they had already included the Philhealth benefits when we paid their PF. Please moderate your greed, Docs!

i was undergo operation last 2007 and under HSP (Health Social Program) according to them i have no pay doctors fee kasi its free of charge na raw kasi nga its a hospital mission daw no doctor’s fee charge to all patients under their program, all i have to pay lang is for hospital bill less philhealth. After successful operation, i saw the bill and it was indicated that the doctor’s fee is “free” and less the philhealth for my bill. 2months after i received the philhealth notification stated that i had a refund for the hospital bill and doctors. I received the check from the hospital but from the doctor she refuse to give me a refund kasi net of philhealth na raw yung fee nya. I told to her that how can i avail your free of service kung mag-claim din pala of my philhealth refund. Stupid! i ask the philhealth ganun daw talaga…ano ba yan!Eh di parang hindi ko rin na-avail your free of service ng doctor, binayaran ko sila.!Grrrrrr….

Well, can we have an option that we will not be deducted with this philhealth shit from our monthly salary? I have lots of bad experiences from philhealth where i have to pay my bill from mcu hospital.

It’s really all a misunderstanding. What the doctors fail to explain properly to patients is that they are able to lower their fee and claim the rest from philhealth. most services are standard per area and are charged based on difficulty. It’s difficult to put a premium on how much worry/difficulty the doctor encounters in order to ensure that the patient is discharged from the hospital well and alive.

Based on the initial case, standard PF was P50000. They did not indicate what case it was but philhealth reimbursement to the doctor would be around 4-7k only. In essence, the patient was given a discount of about 13-17k.

Well have to explain the philhealth has a set of standards and certain fees for each procedure including fees for the doctors and the hospital. It is standard for all hospitals and doctors and the fees are much too low from standards of actual doctors fee. Also doctors and hospitals have different set of standard charges. For example a doctor practicing in a big, state of art medical facility charges about 80k for a procedure, while a doctor from a smaller well equipped medical facility charges 50k for the same procedure. Why is this so? Doctors practicing in the bigger hospital has much more expenses e.g. higher cost of clinic space, secretary, stocks, etc. My advise is to talk with your doctor about fees and charges before hand, if you cannot afford him you are always free to have other opinion with other doctor with the same qualification (same board qualification). If still cant afford try going to a smaller well-equipped hospital or to a government subsidized hospital.

cssmd, i think you entirely miss the point. I respect the rate doctors give the patient, whether it be 50k, 80 k, or 10k for the same procedure. What is objectionable is that, after paying the doctors’ fees as per their given rates, patients expect to get the Philhealth benefits. Your advise about talking to the doctor about the rates is correct but again, the problem is — the doctor did not talk about philhealth. Meaning, in giving the rate, the doctor did not consider the PHilhealth.

It is not a matter of being able to afford, it is a matter of transparency, and of getting the Philhealth benefits due to the beneficiaries.

You can always ask about the philhealth to your doctor but as I said the fees paid by philhealth to doctors are too low and we are not certain on how much we get until we recieve the amount few months after (about 3 months) for about 4-7 thousand. As in the case the doctor discounted his original fee less 20T because of philhealth and more specifically he is a friend of a relative. From that point the patient benefit almost 13-16T. Also, philhealth has standard fees e.g. room rate, OR fees, etc. It is better discussed to patients by the billing/accounting department of the hospital because of technicalities. All excess and those not covered by philhealth are paid and reflected to your hospital bill. Doctor’s fee from philhealth is subject to approval so the best thing a doctor can offer you is a discount or I can say a less of maybe 4-7T depending on the case.

I am well aware that the Philhealth benefits on doctors’ fees are low. But nonetheless, the amount means a lot to Philhealth members. That’s why if the doctors were already paid their fees as billed (with no agreement on who will get the Philhealth benefit), then it is only right and proper that the philhealth benefit should go to the member concerned. The problem here is, members, especially those who experienced hospitalization for the first time are not aware that they are supposed to MAKE A DEAL with the doctor first regarding their philhealth benefits.

Agree with making a deal with the doctor but its not right that the professional fee paid by philhealth should go with the patient. Its a benefit and an assurance that a doctor gets some form of a payment. There will always come a time when the patient is unable to pay the agreed professional fee due to unforseen/added expenses-in reality most are having problems with this. In the end the doctor is the least priority of payment and we cant do anything about it.

Well healthcare involves 3 factors, that is the patient, the doctor, and the institution. The 3 should work hand in hand in order to make healthcare efficient. The philhealth shoulders basic hospital expenses for the patient and pays fee for doctor’s services. In return the philhealth asks contribution from its members in order to avail of its services and benefits. Of course it has its limitations. The bottom line talk and discuss with your doctor about your condition before hand. If you cannot afford his rate and/or the hospital’s rate tell him, maybe he might lower his rate, probably transfer you to a smaller facility, or refers you to a government subsidized facility.

cssmd, you are lecturing on a matter we already know but please ponder on this situation:

A doctor charged his patient P30k (his usual charge) and the latter paid the fee. Later on, the patient learned that his son has philhealth and could avail of its benefits. As regards doctor’s fees, the PHilhealth benefit is say, 8k. Unfortunately, the patient learned only later that the 8k is directly paid to the doctor and when he discussed the matter with the doctor, the latter just told him: “its out of my hands, its the way philhealth does” The doctor did not even suggest reducing his fee.

With the kind of payment system that you try hard to justify, the doctor now gets 38K,right? 8k more than his usual fee. With this situation, what benefit did the member get?

Philhealth is supposed to benefit the member, not the doctor, right?

As I said Philhealth is to benefit the healthcare system, that is the patient, the doctor and the institution, it has to work hand in hand to be efficient. In your case the patient can get refund from philhealth from his hospital bill–i think that’s the benefit, its the bonus because in the first place neither one knows, neither one expects and benefit is the healthcare system.

Perhaps the patient should have asked the doctor first how much does he charged for Philhealth and non-Philhealth member for such procedure before undergoing one. Ethically, the doctor should have lowered his fees after having known that the patient is a Philhealth member; but did not. Hmnn, sounds like a new regulation is needed if there isn’t one yet. Where’s our ever active Congress who’s supposed to be making this laws to avoid this kind of loophole? Also, CSSMD, the institution is already benefiting from the member’s monthly payment of premium, the doctor from the check that the institution issues plus whatever he charges the patient, so where is the member’s benefit if the doctor charges him the same amount with the non Philhealth member? Just wondering….

The Philhealth benefits the healthcare system that is it has 3 beneficiaries– the patient, the doctor, and the institution(medical facilty). In the case, the doctor has the choice whether he gives a discount or just add it to his fee, in the first place the settlement did not involve philhealth at all and nobody knows about it that’s why I said its a bonus-the patient benefits by getting a refund from the philhealth, the doctor benefits by having a fee from philhealth and the hospital being paid of its bill. Its a win all situation.

Plus the patient being treated and being well that’s the most important of all more than the money and the benefits!

Request to all professional & institutional health care providers:

Please do your share to update yourself about PhilHealth benefits. Let us help our PhilHealth members (patients) get the right information. It is not only PhilHealth’s role to educate & inform the members, but also the responsibility of the healthcare providers.

To all PhilHealth members: Always, always communicate well with your health care providers. Agree on the PF and know your diagnosis. If you pay the full amount to your healthcare provfiders, ALWAYS ask for a waiver and official receipt, which are requirements to be submitted to PhilHealth.

AGREE!!!

Mel Santillan, I am pretty sure philhealth members will definitely communicate with their doctors regarding PF but ONLY AFTER they have experienced a previous hospitalization. The issue here involves those who are hospitalized for the first time and do not know the procedures.

What I could not understand is why no flexible policies can be made and accomodated by PHilhealth? I understand the current system is to ensure doctors are properly compensation. But if patients can prove that they have already paid the doctor the agreed PF, as in the example, why can they not ask for the benefit from PHilhealth supposedly due to them?

With this kind of system, surely, you wouldn’t blame countless paying members for feeling that they are being duped. It appears paying members are being punished for this shitty system.

siu I want you to see the whole picture coz ur only seeing from your perspective. Your aware of exodus of doctors from our country, doctors being nurses, lack of doctors in the provinces, hospitals closing, hospital declaring holidays, lack of facilities in government hospitals. I hope you could understand that philhealth is for the healthcare system not just patient per se. What we’re telling is give the healthcare providers what is due to them, give the doctors what is due to them. Communicate with your doctor I guess issues can be resolved. The issue really is education, know your philhealth benefits as a patient, as doctors and healthcare providers should also know theirs.

Phil health is a gift by the state to our people to assist in thier medical bills. The failure to provide complete free medical is one of the most important basic service that our government is unable to provide. thus any behefits coming from this program is definetely for the people and not to our professional doctors enrolling in the program. Doctors might choose their path and thus be financial be well off without any social conscience or obligation, they might even practise in other country as they may wish.

But because of this problem , the program which is very beneficial especially to less fortunate is endagered. Some of us in the barangay level would like to subsidize the actual premium payment so that all our constituent will be able to afford the programand able to avail such privilages.

I am sure that not all medical practicioners are displaying such attitude. I too have a lot of physican friends in the community who actually do time even without compensation and even travel on medical mission to far rural or depressed areas.

If the local barangay and the providers are unable to educate its members, then we failed to do our share in the program.

Lets joined together to make the program workable. P.S. if you have the time, report the doctors, providers, philheath staffs, hospitals and staffs, who are out of line. One day we can educate everybody or entirely eliminate the unwated.

rb

First of all, it’s not a gift if you have to pay for it as RB pointed. Secondly, educating everyone as to how the Philhealth system benefit works, I say yes – maybe. You can educate everybody all you want but if the doctor is in the business solely for the purpose of making more money as in this case presented; having the knowledge doesn’t really mean a thing. The bottom line is it is a matter of ethics. The doctor should posed a question whether what is the right thing to do of the person in need financially or otherwise. And I’m not faulting any doctors, I think they should have the right to do or charge what is due them. After all, studying medical profession is not free and doesn’t come easy just like lawyers do (right ‘Lan?). Here’s my thing, if I was a doctor (ha!) and my patient has a fat wallet, I’ll charge them a million (of course I’m just exaggerating) in an instant. But if my patient is financially unstable, I will charge them knowing that he would be able to sleep when he goes home rather than staying overnight thinking where to get the money to pay for that certain procedure. In totality, I agree that medical/health insurance should be a right everyone must have, not a privilege. Too bad we cannot afford it, not even the US can, or should I say it can but it won’t.

AGREE!!! Just want you all to know that the doctor’s primary objective is the welfare of his/her patient, others are secondary, otherwise he/she shouldn’t be called a doctor. Just understand that we are humans too, we have families too and have to earn our living.

At the risk of repeating myself like a broken record, I have to state that I agree and understand what Philhealth stands for.
I have great respect for doctors and medical practitioners and that they should be properly compensated.
Needless to state, I also agree that on matters of professional fees, it should be based on what was agreed by both patient and doctor.
In short, the above post is not an indictment of the entire medical profession or entire philhealth system, as some smart commenters above appear to presume.

I hope that I made myself clear on those issues. Now, let’s go back to that simple issue about a patient who has paid the full amount of the doctor’s fee and yet, he doesn’t get the Philhealth benefit:::: please stop defending philhealth with those extraneous blah blahs but tell us if something could be done about this apparent anomaly.

The objective im looking at is nothing more than a sense of fairness and equity: the doctor is satisfied with his fee and the patient is duly satisfied with the philhealth benefit. If you look at this positively then it be well to advocate some changes in the system and allow some flexible ways of correcting this apparent flaw.

Do you think that in the above story the patient does not anymore deserve the benefit?

That is the only issue being raised here, no more no less.

What is the essence of PhilHealth if it doesn’t cover more than part of the doctors actual fee?
Well,
1. PhilHealth is mandatory for employers to contribute to. So workers should have it.
2. A worker can’t afford going to the doctor and pay the major part of the PF.

What happens is that a lot of poor workers pay small amounts to PhilHealth that only those rich enough to pay the majority of the PF can benefit from. Or worse, as seen here, that only MDs will benefit from.
The poor can afford the operation, with or without PhilHealth.

“The poor CAN’T afford the operation” it should be…

Glad I found this but was frustrated reading the comments from medical practitioners claiming its a win-win situation.

I guess the member didn’t benefit at all from anything!!!

Maybe doctors could ask patients if they’re a member of Philhealth. I hope this is mandatory.

One more thing, is there ANY way that I can cancel my membership from Philhealth? I mean anything to get them off my payslip.

jmb, im sorry if you’re frustrated with me when i wrote that for me ‘its a win-win situation’.

see the bigger picture, let us not be trapped in the four corners.

i you havent been hospitalized yet, then i would understand, not necessarily accepting your view on this matter.

in case you dont know, you are only paying P100/month to PHIC, and yes you can cancel your membership.

but for poor people (not the self labeled poor) whom in my practice i get a lot, their PHIC benefits spells the MEGA difference.

FYI, if you are hospitalized in a government hospital here in CEBU, if you are a PHIC member, your meds and supplies if available can be given to you charged to your PHIC benefits later, you will only pay for those meds and supplies not covered by your benefits.

in my specialty, even in private hospitals, if you have PHIC, you will only pay the excess (not covered by your BENEFITS), some even wouldn’t even have to pay anything at all. yes, even PF!

lest i be misinterpreted, IM NOT A PHIC APOLOGIST. they also have their MORTAL SINS.

im just sharing my real experience with PHIC and i have seen that it has indeed helped the TRULY POOR PATIENTS.

PHIC is a very discouraging…. For years I’ve been paying….. Last December of 2008; I got hospitalized; And eventually; paid almost 60T for it… Knowing or not knowing; I know I have some refunds from Philhealth… But what the heck… “sad to say”… till now there was no refund… and I heard it will be an almost 7T of refund?…. more heck.. what the heck happen?… 20T, 11T fee for doctors…

WHAT Happen to benefits???!!!… this is not helpful…

we as employed members & our employers pay monthly to PHIC & will continue to do until such time we retire. Pls. make it mandatory to issue all reimbursements to us if we already have paid for PFs in full, some of us had to borrow the money somewhere with super high interests rates that really burdens us on a monthly basis, as in taking half of our daily food off our tables. I am an ordinary gov’t. employee & don’t mind giving bonuses extras to our healers as a kind gesture but really there isn’t any from us to give.

Hello! I am a PhilHealth employee and would like to help.

On PF’s, one problem is that we have no right to regulate how much doctors charge. If, for example, for an operation, they would “normally” charge 20K, and PhilHealth allows for a 5K reimbursement, some simply charge 20K to the patient and say that “kasama na PhilHealth.”

To help avoid this, be sure that your doctor issues an OR. We have been telling hospitals and doctors to use a more or less standard format that states: “less PhilHealth” so all concerned would know if the doctor is filing for a reimbursement and that the patient would immediately get the benefit (by way of deduction).

Kaso, may hindi sumusunod.

Friends, believe me -we are doing our best, but we do not have divine powers. We cannot compel them with absolute certainty.
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On getting your Member Data Record - it usually does not take time. Your best bet is to go to a relatively isolated Service Office, where their clients don’t number in the hundreds or thousands daily.
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On following up your claims: it really is a hassle when things like these get delayed, and I apologize for the rest of us. We receive and process thousands of claims in my regional office DAILY. When people inquire about their claims, we answer based on the status as reflected by our computer system. That’s why you get generic answers like “receiving.” That means we got your claim (and the batch of claims from the hospital that went with it, and we’re in the process of tagging it sa computer so we could track it).
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On benefits: please note that PhilHealth has benefit ceilings (oh, we just increased inpatient benefits by 35%), but it’s not “sky’s the limit. There are ceilings, and there are some cases that are not compensable (such as liposuction). Tip: when in the hospital, prior to checkout, ask for a STATEMENT OF ACCOUNT and ask them to show what the applicable PhilHealth deductions are. That way, you know what you got, or if you are still entitled to a refund (like in cases where medication was bought outside the hospital).

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To make sure you get the check: write the COMPLETE MAILING ADDRESS OF THE MEMBER on the Claim Form 1. Just placing the barangay, or worse, the municipality, is going to get your check lost or delayed.
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Reporting payments: if you are a company, aside from paying through the bank, be sure you submit a remittance report to our office, so we can update the remittance records of your employees.
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Canceling membership: an EMPLOYED member is mandated by law to be covered, so unless you leave employment, you have no choice here. If you are a VOLUNTARY / INDIVIDUALLY PAYING MEMBER, you may simply opt not to pay. Your membership will become “inactive.” Just don’t blame us if you do get sick during that period.

A few other miscellaneous details:

When you get to RETIREMENT AGE, please come and visit us with proof of retirement and proof of 10 years’ contribution, and bring a 1×1 ID card. You will be reclassified as a Lifetime Member and you don’t have to pay a cent.

We do not give pensions. =D

Please help us convince your local officials to enroll under the Sponsored Program those TRULY INDIGENT and cannot afford to pay. We accept any of the poor, and do not practice adverse selection.

Be sure that your employer not only deducts your premium, but actually remits it to us. If they do not, inform us.

When you pay for years and never get sick, and therefore never get to use your PhilHealth - thank God for your good health. I pay P362.50/month as my mandatory contribution and never got hospitalized for the past 10 years. If you want to see where your money went, please visit a government hospital where indigent members are getting care because someone who is employed is paying for them. That’s why it’s called a social health insurance - the rich subsidize the poor; the healthy the sick, etc.

I’ve been working with PhilHealth since 1998. I’m still here because compared to other government institutions, I’ve seen results here - I have heard indigents in remote barangays, mayors, taxi drivers, employees - thanking us for being there. I have heard complaints as well, but rest assured, your complaints are not falling on deaf ears.

Be sure you have your Member Data Record. Keep the original. If the online system goes haywire, at least you’re not bogged down. Submit only photocopies of it.

@vhan,

Where were you hospitalized? Have you inquired with our office to check on the status of your claim? We usually give 60 days for the hospital to submit the claim to us and another 60 days for us to process it. Baka may refund ka pa. Bottomline: PLEASE GET IN TOUCH WITH US.

=)

A few more things:

1. Please put your complete address in the Claim Form 1. We will send your Benefit Payment Notice (BPN) to that address and your refund, if applicable.

2. Be sure you have a copy of your hospital Statement of Account. The hospital is required to attach that when they file their claim with us.

3. We will mail your BPN to you. IF you find out that we paid the hospital more than what they deducted from your bill, bring your BPN to the hospital. They are supposed to give the balance to you.

4. If you have information on fraud : employer fraud, hospital fraud, and even employee fraud - report it to us. Conversely, if you think we did a great job in handling your concerns, inform us as well. Our company emphasizes customer care and satisfaction.

5. Do forgive us for the occasional minor mistakes (like the one getting an ID and got a M1c form). Either the employee concerned misunderstood what the helper said, or he/she was swamped with so many clients that he/she got confused. If you want to see us in action, and you are in Cebu, go to our Members’ Assistance Center at Golden Peak Tower, Gorordo Ave., Cebu City. We handle anywhere from 1,500-2,500 clients a day. God willing, we will have a second branch in Metro Cebu before the year ends.

If you are in the northern part of Cebu, we have an office in Danao City (2/F Gorre Bldg., Rizal St.). I work there.

Sir Leonardo,

I am a Philhealth member. My son was hospitalized last 4th of February. I have forwarded the waiver from the hospital to Philhealth office in Malate last 23rd of Febraury. I was asked to follow up on the 3rd week of April. The girl who recieved the waiver told us that the we can claim 30-60% of the total amount we paid in the hospital (including the doctor’s fee).

Upon admittance in the hospital, we signed a waiver that the medicine available in the hospital will be used and will reflect to the hospital bill before the discharge. The medicine from the hospital is 30%higher than the medicine that can be bought from the drug stores nearby. We were not allowed to buy medicine outside. A month after from the date I forwarded the waiver, I called the Philhealth office. The lady who answered my call asked me” May binili po ba kayong gamot sa labas?” I said “Wala po.” She finally told me that the amount reimbursable will be the amount computed in the hospital. The hospital
did not allow us to buy the medicine outside. They cannot use that excuse. And how come that the person in the hospital (Philhealth coordinator) told me that the computation done in the hospital is tentative, and Philhealth may add to what we can reimburse after the Philhealth doctor scrutinizes the bill. The lady also told me that it will take them 60 working days( excluding Saturdays and Sundays). I also tried to call a the Malate office 15 minutes before 5PM but there was no single answer. Can you answer all of these Mr. Leonardo?

Thank you!

Rhia

Hi Rhia. Pls drop the “o” after my name.

As far as I know, a hospital cannot compel you to buy from their pharmacy. Bawal yung ginawa nila. I’ll double-check with our Accreditation staff tomorrow. If confirmed na bawal nga, I will ask if you can complain sa amin about the hospital, or if sa DOH-Licensing dapat.

(Ask ko lang: why did the hospital not pre-deduct your benefit para wala nang hassle? That’s why there’s PhilHealth nga e: the members should be able to IMMEDIATELY get the benefit while the hospital files the claim and gets reimbursed by us.)

The coordinator was right (the coordinator is not our employee by the way): we would definitely check the claim itself and check if all declared items there are indeed related to the ailment, and if these are reimbursable, according to our rules. The 60 working days are really the standard time to process a claim. Please understand: we process thousands of claims daily, so hindi ganun kadali yun. We (at least sa Regional Office ko) are trying to cut the time to 30-45 days, pero it hasn’t been done perfectly yet.

On no one answering the phone - BAWAL yan. Within office hours pa yan. If you called my Service Office (Danao City, Cebu) before 5:00 p.m., may sasagot talaga. Kahit nga minsan after 5:00, may sasagot, but you would be told na we already turned off our computers. I would encourage you to complain in writing to our office in Malate para matuto sila.

Regards,

Leonard

Sir Leonard,

Thank you for offering your time in answering my inquiries. It was on the third day of my son’s confinement when I found out that the price of the medicine in the hospital is very much expensive than the (same brand of) medicine that can be bought in other pharmacies. I asked one of the hospital staffs about buying the medicine outside, of course to lessen the expenses. She informed us that if the medicine is available in the hospital, they will provide it and it will just reflect on our bill. She also told us to talk to the attending physician and persuade her to give us a request. (allowing us to buy the medicine outside the hospital) The staffs talked to us with a discouraging voice. It should NOT be that difficult for us to get a request on purchasing medicine outside. With all due respect “Making it an excuse not to give what we are due.”

We have decided to apply direct reimbursement. The hospital computed the reimbursable amount which is Php 3,000.00 for drugs and medicine. We paid Php 21,761.45 for medicine. How come that Philhealth can only pay 3,000.00 for the used medicine? Does Bilateral Interstitial Pneumonitis belong to case A? Is it an ordinary case? Last February was my son’s second confinement. He was confined at the same hospital four (4) years ago but I was able to refund (from Philhealth) the exact amount I paid for the medicine.

I tried to call the Malate office to ask them if there were changes with regards to refund but still if not busy, no one in the office wants to entertain the inquiries. I tried to restrain myself from getting angry. I still want to give them (Philhealth Malate Branch) a chance. I’ll call one of these days and if the same thing happens again, I’ll forward a complaint.

I look forward to your reply.

Rhia

Hi Rhia.

No problem. I jsut happened to be online and was supposed to open our webstie, and the title of this blog caught my attention. Let me try ot answer your questions:

How come that Philhealth can only pay 3,000.00 for the used medicine?

-> That’s for case type A. The higher the case type, the higher the benefit ceiling. I have no idea how they compute the ceilings, since I am not an actuary, but generally, it is a balance between what we can afford to pay and what the relative costs for that ailment would be. Being a socialized insurance with the lowest premiums in the market, plus the fact that we do not practice adverse selection (i.e. a very sick person can still apply for membership), we cannot afford to pay the full amount. By the way, beginning April 2, we will be increasing our benefit for inpatient care by around 35%, with no increase in premiums.

Does Bilateral Interstitial Pneumonitis belong to case A? Is it an ordinary case?

-> I asked our Claims evaluators in the regional office and get back to you. We don’t evaluate claims kasi in the frontline. Case type A daw.

I tried to call the Malate office to ask them if there were changes with regards to refund but still if not busy, no one in the office wants to entertain the inquiries.

-> Maybe they don’t know the answer. I’m not trying to make an excuse for them, though. I don’t know the answer either, actually, so I ask others who are focused on that task.

I tried to restrain myself from getting angry. I still want to give them (Philhealth Malate Branch) a chance. I’ll call one of these days and if the same thing happens again, I’ll forward a complaint.

-> Please don’t complain if you are angry (this is a personal advice). Complain if you think you are not getting the right service, with the intention to improve service, give us feedback and also, have your concerns acted on. When you’re angry (at least, in my experience, since I am short-tempered), you may say things beyond what you intended, or say the right thing the wrong way, and as we know, a hurt person would probably not be receptive to constructive criticism.

Regards,

Leonard

Well, just saw these comments and couldn’t say anything at all but ” Improve your performance!” “Wake up Philhealth!” Your questions will never be anwered. Beneficiaries are still suffering. The Philhealth employee couldn’t answer your inquiries because it’s not his concern. He’ll just make an excuse for his associates. He volunteered to help but couldn’t help at all.

and of getting the Philhealth benefits due to the beneficiaries.

my husband is a seaman and he’s the member of philhealth. before his deployment he place me as his dependent. i am pregnant now and due to give birth this may. i wanted to get the deduction directly to the hospital so that i won’t need for the reimbursement. i was wondering on how and where i can get his philhealth i.d and number and MDR.

Mikaela,

Let me preface this by saying that all I have written below are my personal comments.

I’m sorry, but that comment is so unfair. Imagine asking the accounting department of your office, if you are working, about what’s wrong with the air conditioner unit. Do you think they could tell you the answer?

I’m not paid to answer questions online - this is purely voluntary on my part, and I did try to answer as many questions as I could, gratis, but I do not know everything. I do not, and never have, in my entire life, covered up for the faults and flaws of either my office or my officemates. Actually, I started out as a skeptical employee who later saw that despite its weaknesses, the system actually works, and I have heard the gratitude of various people - taxi drivers, a mayor, helpers, the fishball vendor across the street, an employee, etc. - for what PhilHealth has done to reduce their bill. From that time on, it has been more than just a means of getting a salary, but rather, a vocation of sorts.

Regards,

Leonard

Jom,

You can get a copy of his member data record (MDR) from the nearest PhilHealth office. Please bring a photocopy of your marriage certificate.

thank you for your reply…

do i need to present his i.d or philhealth number to get a copy of his mdr?
i still dont have it. the company hasn’t release it yet. they advise me that as soon as i am admitted to the hospital i need to send them a form from the hospital.

hi Jom.

sorry, just dropped by. yes, you need to present any valid ID of your husband or a copy of your marriage contract and your valid ID. that’s for security purposes, so we won’t give out the form to the wrong person.

if you want to check if your record has been updated, pls email me: philhealthdanao@gmail.com. i can check our database for you.

regards,

Leonard

Hi again Jom,

Sorry - the marriage certificate and your valid ID should suffice in getting the MDR. You can get the PhilHealth number card right away, or it may be mailed to you, depending on whether the card printer of the service office you go to is working or not. Ours (in Danao City) is temperamental. Hahaha.

Aside from the MDR, you would need a PhilHealth Claim Form 1 signed by the employer of your husband. You can download one from the PhilHealth website or get one from our offices (most hospitals have them too). I would advise you to get one, get it signed by his employer, and secure the MDR so you do not have to think of details like this when it is time to give birth.

Congrats in advance! God gave us a baby girl last January 8.

Leonard

Ms Rhia,

As a PhilHealth member, you have the right to request for the upgrading of your claim (i.e., from Case type A to a higher category). All you have to do is to write the concerned PhilHealth Office who processed your claim, submit the official receipts of all payments for bills not covered by PhilHealth including the doctor, statement of account and complete clinical chart (from the hospital) to support the upgrading of case type. You may submit these documents within 60 calendar days from the receipt of your Benefits Payment Notice (BPN) at any PhilHealth Office nearest you. The PhilHealth Office particularly Benefits Administration Section will surely look into the matter and will pull-out your claim from thier records to verify the degree or the merit of your request based on the submitted documents and filed claim. If, for instance that your request has been approved, then, the Benefits Administration Section will re-compute the benefits due for you and the payment will be made payable to the member. On the otherhand, if upon re-evaluation of your claim and the claim is still a Case Type A, concerned office will issue communication regarding your request. For the meantime, I would like to ask you if you have availed other PhilHealth benefits like room and board, xray, laboratory and others, doctor fees, because PhilHealth also covers those items subject to adjudication and PhilHealth guidelines.

marlonz

thank you for your reply…i’ve got his mdr without any problem they have prioritize those who are pregnant so i just stayed in the office for a while.

Hi Sir Leonard..

Just want to ask kung po po ba nila nako-compute ung total na madeduct sa hospital bills?Husband ko po ung member, and dependentya po ako.. I gave birth kasi last april 28 in a private hospital.. my bill was Php 16,273 ung nasa total hospital bill.. pero hindi po nka-indicate dun ung PF ng OB ko which is Php 12,500 and ung sa Anaestisiologist na Php 5,000 na binayaran nmin sa kanila ng buo.. Ang philhealth deduction ko lng po na nareceived ay Php 2,500 (for OR 1,060 & XRAY,LAB,OTHERS 1,440).. Tama po ba ung deductions nila? Bakit ganun wala kmeng deductions sa PF? Anu po kayang pwede naming gawin? Nadisappoint po kasi ako ang baba ng deductions.. Inaabot po kme ng almost 43k kasama bill ni baby..

Thank you po.. Hope you can reply po.. Sobrang nalilito po ako eh..

dianna,

Ask ko lang po kung what type of delivery ang inyong panganganak? CS or Normal delivery po?

Marlon is also from PhilHealth but from a different region. Cge bro, tulungan tayo dito.

@Diana,

If normal delivery, fixed talaga ang PhilHealth benefit regardless of the cost. It’s pegged at P 4,500.00 and broken down us follows:

*room and board, drugs, meds, delivery room - P 2,500.00

*professional fee - P 2,000

Naka-package kasi yan (Maternity Care Package)

When my wife gave birth last January, we also got the same benefit (plus P1T for the Newborn Screening Package), even though we paid almost P60T for the whole admission.

Iba ang pagdetermine ng benefit if CS. Hindi na naka-package yan.

keep on sending questions and we are glad to help you in our capacity

marlon

can i use my husbands philhealth? nagatanong po siya sa HR nila sabi daw ng taga HR hinde daw covered ang maternity benefits under his benefirs i’am his legal dependent po.,kaya i/am botherd. pls help me.

ms. luningning,

kung meron pong philhealth contributions ang husband nyo bilang isang empleyado (atleast 3 mos contribution within the last six mos before the availment) dapat po covered kayo sa inyong panganganak bilang isang legal na dependent. Para po sa inyong kaalaman, hanggang apat na panganganak (normal delivery) lang po ang covered ng PhilHealth sa ngayon. Para po sa karagdagang katanungan, pumunta lamang sa pinakamalapit na PhilHealth Office sa inyong lugar.

marlon

as i read the comments regarding md’s PF, i believe siu has the point.MD’S should consider the PF allocated in the Philhealth in determining his/her total PF’s in the entire services rendered..im glad that siu open up this matter as to educate philhealth members and encourage MD’s to be transparent in their PF’s..kudos!

gud day po ask ko lng po kung magkano po ang mare reimburse ko naoperahan po kasi ko sa PGH last MAY 15 2009 kasi po may GALLSTONE po ako, GAMOT lang po ang fastos ko worth 13thousand wala po doctors fee and room… tanong ko lng po how long will it take to claim my reimburse?and how much will i refund. thanks…

ms may,

regarding sa question nyo, sa ward type accommodation po ba kayo ng pgh?, kung ward type, wala po kayong marerefund sa doctor, posible po na sa halip na kayo ang magbayad ng pf ng doktor, e sa philhealth na lang po siya maningil kung accredited siya. Sa room and board, posibleng ganun din ang maging treatment sa charging. Doon naman po sa inyong mga gastos sa pagbili ng gamot sa botika, kung ang gamot po na inyong binili ay ginamit para sa inyong operasyon, maaari po itong marefund. Kailangan lang po ay hindi pa nauubos sa ospital ang inyong PhilHealth benefits para sa mga gamot, naka-generic name ang mga gamot, may official receipt at date kung saan ito ay binili habang naka-confine, nasa listahan ng compensable drugs at nasa PNDF (Philippine National Drug Formulary). Ang mga resibo ay dapat kasama sa inyong PhilHealth claim na isinubmit sa ospital para kasabay ng pagsubmit nila ng claim sa aming opisina. Ang PhilHealth na po ang bahalang magdetermine kung may marerefund pa o wala depende sa inyong claim at resibo. Mayroon pong 60 days ang ospital para isubmit sa PhilHealth ang inyong claim at mayroon din pong 60 days ang PhilHealth para gawan ng aksyon o iproseso ang inyong claim. Kung may refund po, matatanggap nyo ang tseke na nakapangalan sa member kasama ang benefits payment notice. Makipag-ugnayan lang po sa ospital para sa inyong claim o kaya po ay sa PhilHealth Quirino Avenue Branch

marlon

Hi Marlon and Leonard,

Ask ko lang po kung anong forms ang kailangan i-submit tsaka anong documents kung magre-reimburse ako para sa Newborn Screening Package?

Thanks! God Bless po

Erwin,

Para po sa newborn screening package, mayroon pong P1000.00 na subsidy ang PhilHealth. Pumunta lang po sa ospital kung saan umanak ang pasyente at kailangang accredited ito ng PhilHealth at naibigay ang lahat ng services na sakop ng newborn care package. Kung hindi pa naibawas ang inyong PhilHealth para sa newborn care benefits, maaari kayong pumunta sa pinakamalapit na opisina ng philhealth para isubmit ang PhilHealth claim Form 2 (galing sa ospital) at Form 1 (filled-up by member at employer kung mayroon) at iba pang dokumento na magpapatunay sa pagiging philhealth member. Maaari din pong makipag-ugnayan sa ospital para sila na lamang ang magproseso ng claim. Mayroon po kayong 60 days pagkalabas ng ospital para isubmit ang mga requirements.

marlon

Thanks Marlon! Buti na lang nasabi mo na kelangan ko ng claim form 2 galing sa ospital.

thanks din siu dahil sa post nya

I find this blog very interesting, my commendation to SIU for the post. Just to comment re: PFs of doctors, I think this is one of the professions where we cannot have control over how much they charge for their patients (even the PRC and DOH does’nt have control over their rates, what more for PHIC). It is but fair that doctors should have transparency when it comes to how much is their asking fee, inclusive of PHIC benefits. It’s just a matter of professional ethics. However, if the doctor still ignores it then bahala na ang KARMA (what goes around, comes around) sa kanila.

I am a philhealth member under the Individually Paying program and I already used it twice for the Ceasarian operation of my wife. Had it not been for the PHIC benefits that were accorded to us, hindi ko alam kung saan ako maghahanap ng pangtustos sa panganganak ng misis ko. We are already in the 4th year of continuously paying our premium (a total of P4,800.00). And then yung dalawang ceasarian operation ni misis, more or less ang total is 32k. Fortunately, admitted siya sa isang government hospital at wala kami nabayaran na PF dahil gov’t doctor yung nagopera sa misis ko. Bahala na daw yung PhilHealth na magbayad sa PF pero yung PF daw is hindi rin mapupunta sa kanya. mapupunta daw sa Pooled Fund ng hospital na paghahatian naman ng lahat ng mga empleyado ng ospital.

Sa tingin ko, there are members who appreciates the benefits PHIC and there are those who dont. That depends on situations. Paano na kung wala kang philhealth? E di hindi lang PF ang babayaran mo. Babayaran mo na pati medicines, laboratories, room and board, operation room fee at kung ano-ano pang fees na ginamit mo sa ospital.

mr. lagod,

thank you for your comment, sana marami pa ang matulungan ng philhealth…

more power..

marlon

Sorry for being silent for a long time. We’ve been busy preparing our new Service Office in Mandaue City, Cebu and with my business as well. I am glad my colleague and friend Marlon has continued to address the concerns of our valued members.

hi this josh and i need some help here….
i dont know my philhealth number?
cause my previous company told me that i already have one the problem was she dont give me my philhealth number….

and how can i get a philhealth card? is it considered as a valid id?

cause in what I’ve heard you just give the number and just wait and you can claim your card? with out cost…. is it true? hoping for your immediate reply….. tnx More power guy’s

Josh,

Once you have PhilHealth number, it is your lifetime number. If you happened to be employed and issued a PhilHealth number, then all you have to do is verify it to the nearest PhilHealth Office located in your area or call our office at 6379999. I’m sure, any PhilHealth Office will attend to your query and glad to give you copy of your ID without cost by just presenting any valid ID’s and letter of request for replacement. Just incase you are now a self-employed (with PhilHealth number already), you may opt to change the status of your membership or records with Philhealth by accomplishing PhilHealth Form M2.

Also, please be informed that we have online database and if you don’t mind, I can check your records on realtime by giving me your fullname, address and birthday.

Thank you

I would like to commend Leonard and Marlon for helping Philhealth members by answering their questions. Although I am not a Philhealth member myself because I now live overseas, I am curious and sometimes check the status of Philhealth services because I’ve been paying for four of my sibling’s membership for a few years now. 3 years ago one of my sisters was hospitalized underwent surgery. Although she received the benefits a few months after, she never had problems claiming her benefits. For those who are Philhealth employees who work hard to help our kababayan, even though we don’t know you, you are appreciated. For those doctors who take advantage of some patients…like someone wrote here, KARMA na lang. And for those doctors who stay in the Philippines and use their skills to help their kapwa Filipinos, you are our heroes!

ms. cecilia,

Thank you for your message, although this blog or site is for attorneys concern, we would like to thank the author of this blog because through this, we can help many PhilHealth members regarding their concerns.

More power!

Hello po… Good day… Jumz here from Cebu…

Magpafile po sana ako ng claim for my brother’s hospitalization sa PhilHealth as my mom’s dependent… Actually, yung mom ko sana ang magpafile nito sa province namin, Masbate, but the PhilHealth officer there told my mom na sa may pinakamalapit daw na PhilHealth office kung saan naconfine yung bro ko and since he was confined in Chung Hua hospital here sa Cebu so dito na lang…

My mom told me that before I file the said claim form, I should get a WAIVER from the hospital kasi kailangan daw yun but when I browsed PhilHealth’s website ang nakalagay is, as one of the requirements, “Official Receipts OR Hospital and Doctor’s waiver”.

My question is, doI really need to get the waiver? Kasi ang nakalagay naman is “OR” which means either of the two, right? I already have all the ORs that the hospital issued after my brother was discharged/ after we paid the hospital bills.

And if kailangan talagang kumuha nun, do I have to go to both doctros? kasi dalawa yung attending physician nung brother ko…

I already have all the forms na din (Forms 1, 2 and 3)… Direct reimbursement po pala ang ipafile ko… hehehe…. Sori… First time filer po…

Plano ko sanang pumunta sa Regional office to ask this, kasi malapit lang sa amin, kaso nga lang parang parati po yatang puno yung office and I doubt if I get entertained immediately… May traumatic experience na kasi ako with government offices kaya nagdadalawang isip pa ako na pumunta sa office… Haayysss…

Yun lang po sana yung tanong ko…. Sorry, I know my questions are too simple but as I said, first timer po… Pasensya…

Hi,

How long does it usually take for Philhealth to process new applications? My company submitted mine 2 years ago, but we still haven’t got it. I already got my receiving copy, and called up Philhealth to follow up. Unfortunately, the Philhealth branch, where our company filed was decentralized. Ours were moved to the Makati branch. I tried to call up their number and also sent an email for instructions. However, I haven’t received any helpful reply. After searching google, I found this thread. Maybe someone could help?

There is the option of just going to Philhealth’s office. But that would entail sacrificing my office hours. Moreover, I want to be sure about the steps before I actually go there. I don’t want to be passed around from one department to another.

Does anyone here know where or who I could contact for assistance?

Any information on how to follow up the elusive Philhealth number would be of great help! Thanks!

MC

Jumz,

hindi nyo na po kailangang kumuha ng waiver sa ospital o doktor kung mayroon na kayong resibo ng mga pinagbayaran sa kanila at makikita ang buong halaga ng hospitalization. Kung mayroong pagkakaiba sa forms at resibo, karaniwang hinihingi ang waiver sa hospital at doktor para maisaayos ang mga pagkakaiba. Pumunta lamang po sa aming opisina sa Cebu na makikita sa Golden Peak Hotel. Narito po ang mga dokumento na inyong dadalhin sa aming opisina;

1. PhilHealth Claim Forms (1 and 2)
2. PhilHealth Claim Form 3 (case to case basis)
3. Official receipts of hospital and doctor or waiver
4. MDR
5. Proof of payment (if self-employed, OFW)
6. Sponsored Card (if Sponsored member)
7. NPM ID (if retiree)
8. Clinical chart (case to case basis)
9. Operative record (if the case is operation)

thank you

MC

here’s the procedure for philhealth registration:

Fill out M1a Form (in duplicate) (downloadable to our website)
Attach clear copy of supporting documents for qualified dependents declared
Submit to the HR Department for them to forward the above documents to PhilHealth together with Er2 Form (Report of Employee-Members).
After processing, PhilHealth will send the member, through the employer, his/her PhilHealth Identification Number or PIN and a copy of the Member Data Record

Please coordinate with your HR personnel because they are supposed to be the one who facilitate the registration of thier employees. But please feel free to call our office at 6379999 and ask for the office who handles your concern, (membeship and marketing department)

thank you

MC

here’s additional phone numbers that you can call for your concern:

6371284, 6378239 (telefax)

email add: info.prolp@philhealthh.gov.ph

thank you

for your other concerns, just add my chikka account - 009384661
email address - mgmaravillaph@yahoo.com
skype account - marlonmaravilla

you can check me through these online channels

thank you

Heloo po sa may mabuting kalooban, hihingi lang po sana ako ng advice sa inyo. Im glad may ganitong site to help us na walang pang experience sa pagclaim ng philhealth. Ang aking anak ay naaksidente nun nakaraan feb 23 and na discharge nung feb 27 this year, 4 days kami sa hospital, nagundergo po sya ng operation from his right arm shoulder going down to his back.. (sobrang sakit po sa kalooban naming mag-asawa ang pangyayaring ito). Nag5050 po ang bata dahil naging irregular ang hearbeat nya. Sa sobrang sakit po sa amin di ho kami pumayag na di sagutin ng driver ang gastos. ang naging sitwasyon 1 and 2 day ay nasa hospital sila then 2nd and 3rd day ay wala na sila mabigay dahil wala na rin daw silang pera… so wala po kaming magwang paraan kung di hugutin ang pera na sapat lang sa budget namin. 4 po ang anak ko, halos nagkandautang din kami. nung sinabi na ng dr na kailangan nang ilabas ang bata tnulungan pa namin sila para lumapit sa swa kaso aya nila magbigay ng discount dahil obligasyon daw iyon ng nakaaksidente. nasa 8k po ang bill half lang nito ang nabayaran nila. and other is nagpromisorry sila. Ang tanong ko lang po paano ko ho maclaim ung mga gamot na nabili ko from drugstore . Public hospital lang po ang ospital na napuntahan namin. Pde na ho ba kami dumirekta sa philhealth office?

Pakitulungan lang po kami dahil ung maclaim namin ay magiging tulong din po sa aming anak lalo na sa mga ganitong pagkakataon.

Maraming Salamat po.

Lourdes

Ms. Lourdes,

Unang una, bago magamit ang PhilHealth, kailangan accredited ng PhilHealth ang ospital kung saan naconfine ang pasyente. Pangalawa, may sapat na contribusyon ang member sa PhilHealth at legal na dependent ang pasyente (sabi nyo po ay anak nyo ang naconfine kaya walang problema dito). Kung na-satisfy po ang lahat ng mga ito, saka pa lamang magagamit ang PhilHealth sa ospital. Kung kumpleto ang requirements bago lumabas ng ospital, dapat ay binawas ng ospital ang mga PhilHealth benefits sa inyong bill para yung excess na lamang ang inyong babayaran (o kung sino man ang babayad). Kung may mga original na resibo ng mga gamot na binili sa drugstores, maaari itong isama sa inyong PhilHealth claim na isinubmit sa ospital para ma-evaluate ng aming Claims Processing Division kung pwede pang bayaran at may natitira pang benefits ayon sa aming benefits schedule. Lagi pong tandaan na ang mga gamot lang na binili habang naka-confine at nakalista sa PNDF ang maaaring bayaran ng PhilHealth.

Sana po ay naliwaganan kayo sa aking sagot.

Hi. I am a Philhealth Member and I gave birth last October 2009 in a government hospital. I was planning for a normal ceasarian kaso nung manganganak na ako at nakapila ako sa “charity”, ang tagal i-entertain kasi marami daw nauna. When I felt that I might collapse, I asked the attending physician what can I do para maasikaso ako agad because I wanted a no-pain delivery. Sabi nya ipatawag ko yung ob-gyne ko then to negotiate. Tinanong ko yung physician kung may marerefund ba ko sa philhealth kung ganun yung gagawin ko, meron daw.

So pinatawag ko na yung ob. Yung kapatid ko yung nakipagnegotiate and they agreed on 20,000 including her fee, the anesthesiologist’s fee, and the pediatrician’s. I remember after giving birth kahit hinang hina pa ako tinanong ko yung anesthesiologist kung may marerefund ako. Sabi nya meron basta humingi daw ako ng receipt sa OB.

And then came the billing. The hospital bills were deducted appropriately but I had to pay the OB first to be able to get out of the hospital. So my sister paid her through her secretary and asked for a receipt. Instead the secretary gave her an Rx paper with the professional services and corresponding fees written. So my sister asked for an official receipt because we’ll need it to reimburse even just a fraction of the PF. The secretary gave her a receipt but said that we won’t be able to get any refund since the refundable amount will go to the OB.

Please tell me if what the secretary said is true and how come. If so, what can I do to get the refund. I think it’s unfair if the refundable amount also goes to the doctor. It would be like paying for a ceasarian delivery.

Ms. Vhel,

Unang-una, kailangan po malinaw sa usapan ng doktor at pasyente o member kung magkano ang babayaran sa doktor. Kailangan din po na linawin kung ang babayaran sa kanya ay bawas na ang PhilHealth o hindi pa. Kung bawas na ang Philhealth sa kabuuang halaga, yung excess na lang ang babayaran ninyo sa doktor at dapat nakalagay sa resibo kung magkano ang binawas sa PF. Sa ganitong kaso, kapag binayaran ng PhilHealth ang claim, sa doktor na po mapupunta ang refund dahil automatic na kayong binawasan ng benefits sa doktor.

here’s a link for information
http://www.philhealth.gov.ph/forms/others/askyourdoc.pdf

Hello Marlon / Leonard and iba pang mga taga Philheath na matyagang sumasagot sa mga inquries dito. Mabuhay kayo! Parang ang hirap na humanap ng ganyang mga tao sa Pilipinas

I had all good experiences with Philhealth when I was in the Philippines. Aside from the doctor’s fee, i always get around 35-45% of fthe hospital bills. I also make it clear with the doctor if the PF that will be charged is net of Philhealth.

I am now an OFW Philhealth member. My father, who is one of my dependents, has undergone bypass surgery recently. He needed to pay 400T upfront, in cash, to proceed with the operation. The hospital said it is a package deal so there are no breakdown in the official receipt. My family can’t do anything but to go ahead since my father is in a critical condition that time. There are additional charges of around 70T after the package which is what then subjected to Phillheath deductions in the hospital. This is where almost 35% has been deducted.

My question is - can we still file claims for the 400T that we paid?

Thank you.

I dont think the hospitals know about this Or nagbubulagbulagan kang sila? Can Philhealth help to implement this? What about if the member or dependent has a hmo? How should the computations be made?

PhilHealth Guidelines for Members & Dependents to Implement the Relevant Provisions of Republic Act (R.A) 9257, Otherwise known as the “Expanded Senior Citizens Act of 2003”

I. COVERAGE This circular shall apply to all PhilHealth members and dependents who are 60 years old and above; and to all accredited PhilHealth institutional health facilities and health care professionals.

II. APPLICATION OF SENIOR CITIZENS’ PRIVILEGE FOR HEALTH SERVICES
With regard to the implementation of R.A. 9257 and pursuant to Administrative Order No. 177 s-2004, the following are the application of senior citizens discount for health and dental services
D. Twenty Percent (20%) Discount on Services of Health Care Professionals
Professional fees of attending health care professionals in all private hospitals and medical facilities for medical, surgical and dental services rendered to senior citizens shall also be given a of twenty percent (20%) discount.
III. RULES on the APPLICATION of the SENIOR CITIZENS PRIVILEGES to the AVAILMENT of PHILHEALTH BENEFITS
B. Twenty Percent (20%) discount on services in Pay Sections of Government Health Facilities and in Private Health Facilities

In a setting where the PhilHealth member or dependent will be provided the 20% discount or hospital services, the health facility must first deduct from the total hospital charges, the amount representing the 20% thereof. Only the remaining 80% or a portion of which, is chargeable correspondingly to PhilHealth.

Hi. I’m a philhealth member - individually paying - im going to be giving birth by next month and would like to know what philhealth papers i need to bring to the hospital with me. Also from what i understood, when you give birth(normal delivery) the amount philhealth deducts is fixed ?tama po ba? and is it 4500 or 6500 kasi may nabasa ako parang may increased yun deduction pag mag give birth.

Also, i read about getting the doc to sign a waiver to help with prof fees….. do i also need to do that in my case or is that for operations etc… or is that something i have to discuss with my OB?

Tapos if i have all the papers, yun deduction ng philhealth will be deducted agad sa hospital dba? kahit yun new born screening? so i wont need to go pa to philhealth for a refund or is there something na refundable pa?

if CS ako, paano yun deductions? would it make a difference if scheduled CS ako and if biglaan like of i try normal delivery then have to change to CS for some reason.. what will i get from philhealth?

I’ve been paying for philhealth for more than 2 years na, first via the company i worked for then when i left i changed to individually paying and am covered till june.

Hope someone can answer my questions.

tentay,

Para po sa inyong kaalaman, mayroong benefits ceiling or limit ang PhilHealth. Ang benepisyo ay ibinabase sa sakit at sa klase ng ospital kung saan naconfine ang pasyente. Sa inyong kaso, mahirap sabihin kung may marerefund pa kahit kaunti sa inyong nagastos na 400k o wala na dahil hindi ko po actual na nakita ang claim at ayon po sa inyo ay nabawasan kayo ng almost 35% sa inyong additional bill na (70K). Ang maipapayo ko lamang po ay hintayin ang inyong kopya ng benefits payment notice na ipinapadala ng philhealth sa myembro kapag naprocess na ang claim at ikumpara ang statement of account at binayaran ng philhealth. Kung may katanungan, maaari po kayong magtungo o kung sino man sa pamilya nyo sa opisina ng philhealth para sa karagdagang kaalaman.

hmo,

mayroon pong mga hmo na kailangan munang bawasin ang philhealth bago ang hmo magbayad ng para sa kanilang benefits. Mangyari lamang po na tingnan ng mabuti kung ang hmo na inyong kukunin ay inclusive or exclusive ang philhealth. Ang ganitong kaso ay ayon sa aming experience sa mga claims na aming nakikita.

Doon naman po sa discount para sa senior citizens, malinaw po ang nakasaad sa philhealth circular at ang kopya po nito ay ipinapadala sa lahat ng accredited hospitals ng philhealth

tanya,

tama po ang benepisyo para sa normal na panganganak ay P6,500. P2500 - hospital facilities, P2500 - physician fee component, P1500 - pre-natal fee component.

check this link

http://www.philhealth.gov.ph/circulars/2009/circ39_2009.pdf

Kung CS naman po kayo ay depende po ang benefits sa ospital na inyong pinasukan at sa limit ng PhilHealth benefits

Kapag kompleto ang inyong mga requirements (Form 1, proof of payment, MDR), automatic po dapat na ibawas ang philhealth benefits sa inyong bill bago lumabas ng ospital (accredited).

Para sa karagdagang kaalaman, nagpapapirma o humihingi lang po ng waiver of full payment kapag kayo ang nagbayad ng buong hospitalization at doctor fees (kung di binawas ang philhealth sa bill)

Ang PHIC ay nakakatulong sa:

1. Purchase ng mga gamot
formula :
Net meds = (Meds/supplies - PHIC)

2. Room and Board ng ospital:
formula:
Net Hosp Bill = (Room & Board - PHIC)

WALANG KWENTA sa

1. PF ng Doktor
formula:
(Doctors fee + PHIC) = Total PF -PAWNED!!!!

Thats in 99 percent of of cases, granting there is a “whooping” 1 percent of patients are their relatives, fwends, …

And please dont tell us about your mouths to feed nor yer bills to pay. Just look at the formula, OK?

I strongly suggest that the formula should be:
Net Docs fee = (Docs Bill - PHIC)

Aminin na natin na tayong mga doktor ang mga bampira.

Quotes overheard:
“paano naman ako? yung colleague ko nga na si doc x, malaki na ang bahay.. kasisimula pa lang nya ah.”

“aw! nakabili na si doc Y ng 3rd generation na Toyota Prius, Dapat ako rin.”

” Ano? 7th time na nag tour abroad si Doc Z? At kasama pa ang family? Hayaan mo, ako 12 beses mag trip abroad this year.”

PS, I fed my family and have a descent lifestyle without extracting exorbitant fees from my patients.

anti-vampire,

tama po, dapat po talaga maramdaman ng members ang benefits para sa doctor para po lubos na makatulong ang philhealth sa mga members.

Actual PF - PHIC = Excess payments to be made by members

excuse me nga broders, dapat siguro mainform nyo ang mga philhealth members patungkol sa mga benefits n ddpat na makuha nila lalo na sa mga province, masasabi ko na isa na kami sa naloko ng mga doctor na nagpaanak sa misis ko 2 times , both of us are members,and then wala ni sinko kami nare inburst sa hospital na yun

Good Day!
Im already a member of philhealth. ask po sana ako kung saan ko po pwedeng kunin yung philhealth id number ko po. im currently staying her in malate,manila.

thank you

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