Philhealth Manipulation And Issues.

[Bruce]

Out on Samar, they did a little remodeling of the hospital and changed things around to make it a PhilHealth hospital. But it really is business as usual. The local hospital is little more than a first aid station or a place to die. The only surgery they do is the occasional C/S. For anything serious, they refer the patient to the government hospital in Tacloban which is about 85 miles away. How the patient gets there is up to the patient.

 

In the US, it would be called patient dumping and carries a fine of 50K for each occurrence. What the local hospital is now doing is that they run up the PhilHealth bill as high as they can and then dump the patient to Tacloban. The issue with that is there are caps on what PhilHealth pays and the local hospital on Samar knows this so they try to get a big chunk of that money and then when the patient is dumped, there is not enough coverage left to help the patient.  

 

There is also a 'sharing' plan with the hospital staff who is supposed to get a % of the payment. So there is a further conflict of interest in that the staff wants the hospital to get the biggest payment possible from PhilHealth. The more the hospital collects from PhilHealth the greater (but still small individually) the share for the staff members.  

 

In this case, the woman you see in the pictures is an elderly diabetic and needs her foot amputated. She is the grandmother and care giver for a boy who my charity pays the school fees for via donations. His parents are long gone and so he lives in his grandmother's 1 room shack.

 

The doctors in the hospital are milking the PhilHealth program by prescribing costly medications rather then less expensive medications, all the while knowing that the foot will not recover, gangrene has set in and the woman is in the express lane to death unless she has the foot removed. So they will 'tell her' she needs to go to Tacloban but then still keep her in the hospital collecting PhilHealth money for the room and medications until the cap is reached. Then they will tell her that there is nothing more they can do and send her home. The hospital is billing her 2,500 a day. And she and her friends and family are all squatters without the ability to understand the way the hospital is manipulating the situation nor are there any resources for them to complain to.

 

Is this the way PhilHealth is working in other areas, or does it appear that it is isolated to the rural areas with no real surgically equipped hospital?

 

   

[JJReyes]

Bruce, is there a website or a list in PDF format that give you the reimbursement information from PhilHealth to a medical clinic or hospital? I want to make a comparison for a slide presentation this November to a Fil-Am group.

 

In the United States, our Medicare is a co-pay system. My wife has Medicare A, B, C & D. Every visit to a doctor and we get a $5.00 co-pay. The hospital bills both Medicare and the health insurance company for $145. Recently, she sent an email asking a minor medical question. The email response came from a nurse with a one liner reply. We got the $5.00 co-pay. $145 was billed to Medicare and the health insurance company for medical consultation. I was going to complain, but $5.00 is not worth a fight. 

[Bruce]

Bruce, is there a website or a list in PDF format that give you the reimbursement information from PhilHealth to a medical clinic or hospital? I want to make a comparison for a slide presentation this November to a Fil-Am group.

 

In the United States, our Medicare is a co-pay system. My wife has Medicare A, B, C & D. Every visit to a doctor and we get a $5.00 co-pay. The hospital bills both Medicare and the health insurance company for $145. Recently, she sent an email asking a minor medical question. The email response came from a nurse with a one liner reply. We got the $5.00 co-pay. $145 was billed to Medicare and the health insurance company for medical consultation. I was going to complain, but $5.00 is not worth a fight. 

 

I am not sure about any websites to compare costs. My information comes from Pam who is there in Catbalogan and people come by asking for help. She took the pictures yesterday. Basically, the grandmother is 'done'. Business as usual.

 

As for the US and billing practices, If you go to a doc and get a prescription for an inhaler, the office staff will 'instruct' you how to use the inhaler and yes, your insurance company will get billed for that 30 second instruction!

[jpbago]

It is all about money, all of the time. My experiences with Philhealth last month when my daughters both got dengue was not good. See the postings under "Dengue" Philhealth paid only part of what their website said. Even the posters in the hospitals did not reflect the amounts that Philhealth actually paid.

But, I have since found out that if you sign a waiver saying that you will pay the entire hospital bill and then you will make the Philhealth claim yourself, you will get more from Philhealth. If you let the hospital do the claim, they take 50% of what Philhealth pays. If all you have is Philhealth, then this is the way to do it. Also, it is better if you pay the doctors yourself.

If you have another insurance with Philhealth, then it probably does not matter as the other insurance pays the balance of the amount left after Philhealth pays theirs. I would imagine that the other insurance would ask you to make the Philhealth claim yourself.

[JJReyes]

How exactly does PhilHealth work?

 

I know everyone is now required to pay the minimum premium of P450 per quarter or P1,800 a year. If you visit a medical clinic, does someone in accounting collect your PhilHealth card and cash deposit before you see the doctor? What happens after? Do you go back to accounting and settle. I assume they will refund any remaining balance on the deposit or does the cashier smile and say, "Thank you."

 

My Medicare is Part A & B. The Part B is a $104.95 automatic deduction from my Social Security monthly benefits. If I see a doctor, Kaiser Hospital bills me $33 a visit and the remainder of the bill goes to Medicare for reimbursement.

 

My wife has Part A, B, C & D. $104.95 is deducted from her Social Security monthly benefits. She pays an additional $143 a month to Kaiser Health Plan. If she visits a doctor, her co-pay is only $5.00 The additional insurance (Part C & D) math works if you need other services such as surgery or specialized treatment like chemo.  

[jpbago]

Posted Yesterday, 08:57 PM How exactly does PhilHealth work?   I know everyone is now required to pay the minimum premium of P450 per quarter or P1,800 a year. If you visit a medical clinic, does someone in accounting collect your PhilHealth card and cash deposit before you see the doctor? What happens after? Do you go back to accounting and settle. I assume they will refund any remaining balance on the deposit or does the cashier smile and say, "Thank you."

 

Philhealth works differently at different hospitals just like everything else is here with no set of rules or consistency.

At one hospital, we had to present our Philhealth card and receipts to show that we were paid up. Then we had to pay 5000p deposit, then every two days, we had to pay more, like 10,000p or more. Then the doctor asked to be paid in cash as it takes 3 months for the hospital to pay him. He gave us a small discount. Then I had to pay the balance after Philhealth credit before the guy at the door with the gun would let us out.

At the other hospital, it was the same except the deposit was 3500p. I asked why Philhealth did not pay the amount shown on the wall. She smiled and said: "But you are a foreigner so you can afford to pay." I just wanted to get out so I paid the bill. It is our fault for being here.