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							    The Monthly Newsletter of the Philippine Health Insurance Corporation                              Volume 1 No. 02


                                                                                      PhilHealth On-Line system was
                                                                                      made accessible right in their own
                                                                                      computers. The pilot-test was initiated
                                                                                      to gather feedback from internal
                                                                                      users about the system before its roll
                                                                                      out to all PhilHealth branches in the
                                                                                      National Capital Region and to the
                                                                                      Regional Offices. To date, PhilHealth
                                                                                      is awaiting the delivery of the
                                                                                      hardware that will support the system.
                                                                                          The Second Phase will be the roll
                                                                                      out for the public after the successful
                                                                                      implementation of the pilot-test in
                                                                                      the NCR and Regional Offices. To
                                                                                      get into PhilHealth On-Line, site



PhilHealth pilot
                                                                                      visitors need to register online. With
                                                                                      the development of PhilHealth On-
                                                                                      Line, members and employers will



tests on-line
                                                                                      soon have a prompt and convenient
                                                                                      way of securing the PhilHealth




inquiry
                                                                                      information they need, without
                                                                                      having to leave the comfort of their
                                                                                      homes or offices.

                                                                                        Countdown to
                                                                                        Universal Coverage
by Evelyn P. de Leon                                                                    These LGUs have achieved
                                                                                        at least 100% coverage as of
A new method of inquiring about              as the Member Data Record and the          December 2008:
claims status and similar basic              posted contributions may also be          Highly-urbanized cities
information on their membership              printed for the member’s use.              1. Angeles       6. Marikina
will soon be available for all                   There are two ways to access the       2. Bacolod       7. Municipality
                                             information that members need: by          3. Cagayan          of Pateros
members of the NHIP. Dubbed                                                                de Oro        8. Navotas
                                             using the PhilHealth Identification
PhilHealth On-Line, the project                                                         4. Iloilo        9. Quezon
                                             Number or by typing in the member’s        5. Makati       10. San Juan
will enable members to gain
                                             complete name. Employers may also
quick responses to their inquiries                                                     Provinces
                                             use the system to verify information
via electronic means. It was                                                            1. Aklan        15. Iloilo
                                             by using their PhilHealth Employer         2. Albay        16. Laguna
developed by the Information                 Number or by using their registered        3. Bataan       17. Lanao del
Technology Management                        business names.                            4. Batanes          Norte
Department (ITMD) as part of                     The project comes in two phases.       5. Batangas 18. Lanao del Sur
the Database Integration and                 The First Phase is now being pilot-        6. Benguet      19. Misamis
                                                                                        7. Biliran          Occidental
Inquiry Support System.                      tested at the Central Office. An
                                                                                        8. Bukidnon 20. Misamis
                                             orientation was recently conducted         9. Camiguin         Oriental
   Through PhilHealth On-Line,               by ITMD personnel to familiarize          10. Capiz        21. Nueva Vizcaya
members may verify the following             Central Office employees particularly     11. Eastern      22. Pampanga
information: their membership                the frontliners assigned at the PMAC          Samar        23. Siquijor
profile, the list of their qualified legal   on the use of the system. Registration    12. Guimaras 24. Surigao del
                                                                                       13. Ifugao           Norte
dependents, their contributions and          forms were distributed to frontliners     14. Ilocos Norte 25. Tarlac
availment records. Documents such            for them to fill-out after which the                   Partial List

April 2009                                                                                     Feel Health / Volume I, No. 02
          Volume I No. 02

        In this
         Issue

                                                    Summer is here!
    Parang Service
    Office Now
    Open............................. 03

    Tubex Still


                                                 A
    Compensable.............. 04                           fter an extended season of cold weather up until mid-February,
                                                           summer is officially here, making swimming pools, beaches, ice
    Benefits for PF                                        cream and halo-halo even more inviting.
    Up by 40%................... 05                  At this time, I am sure people are beginning to pack things up and take
                                                 that longed for vacation or a trip to the beach for a day or two.
    Kawayan Festival                                 But before hitting the road to worship the sun, the seas and the sands,
    2009: Uniquely                               it pays to rethink that long list and revisit your baggage to make for a
    Koronadal!................... 06             healthy and safe trip and make the most out of that vacation. Is sun block
                                                 with the right SPF already tucked there? How about that shades and wide-
    Employer monitoring                          brimmed hat or your favorite baseball cap with cute drapery around to
    made easy................... 07              protect your ears and neck from the scorching heat?
                                                     But having all those gears cannot entirely shield you from the sun’s
    DFA Desk: Still                              UV rays especially between 10 AM to 3 PM. So bask in the sun either
    Serving OFWs............. 08                 early or late in the day to get yourself out of painful sunburn.
                                                     Kids prove to be quite stubborn and persistent too when it comes
    Multiple Deductions                          to SAW (swimming against your will) so bring along some board games
    from Multiple                                and toys to keep them indoors. Be extra cautious too about the safety of
    Employers.................... 09             your food. Freeze what there is to be frozen to prevent unwanted bacteria
                                                 spoiling your food. And pack only the freshest vegetables and the season’s
    Accreditation a                              fruits for a healthy and watery treat against dehydration.
    Must for Hospital                                Before I forget, why don’t you bring this copy of Feel Health’s April
    Chiefs........................... 10         issue to include in your reading fare while tanning or enjoying the cool
                                                 shade in a hammock? We have loaded this edition with the latest about
    Refusing to Deduct                           your PhilHealth to keep you well informed and updated while away from
    Benefits: Are HCPs                           home.
    Liable?.......................... 11             One last piece of suggestion though: Read through and when done,
                                                 pass on to the sun worshipper next to you.
    PhilHealth is                                    Happy reading!
    “Kaagapay Mo!”
    on UNTV 37................. 12                                                                VP Ruben John Basa
                                                                                                     Editor-in-chief



  The Team Behind                          Editor-in-chief : VP Ruben John Basa
  Feel Health                              Contributors for this issue:
                                           Moppet Varlez, Rey Baleña, Evelyn de Leon, Glo Pactores, Pinky Aragones,
                                           Joni Yao, Tintin Besmonte, Guia Subillaga, Leyn Betonio, Hanah Naanep
  1704 Citystate Centre                    Photos : Nitto Pineda
  709 Shaw Blvd., Pasig City
                                           Layout and design : Noc Nisperos

Feel Health / Volume I, No. 02                                                                                        April 2009
                                                                                                       Corporate
                                                                                                       Updates




   Atty. Reynaldo Capangpangan, Area Vice President for
   Mindanao leads the ribbon-cutting ceremonies.




Parang
Service Office
Now Open
                                                                       Atty. Khaliquzzaman Macabato, Regional Vice
By Maria Sophia B. Varlez                                              President for ARMM, addresses visitors


In yet another daring move in             Chief, Field Operations Division
the name of genuine public                and Concurrent Overseer of
service, PhilHealth has formally          the Parang SO, they are ready
established its presence in the           to serve clients from both
municipality of Parang, Shariff           Provinces of Shariff Kabunsuan
Kabunsuan in the Autonomous               and Maguindanao that have an
                                          estimated combined population
Region in Muslim Mindanao.
                                          of about 1.2 million.
   The new office, known as Parang            The Parang SO was the
Service Office, has ten (10) dedicated    first SO established since the
staff members who provide over-the-       PhilHealth Regional Office –
counter collection services, receiving    ARMM went full-blast in its
of PhilHealth claim documents from        regional operations. It is located                                   Lean team of Parang SO
accredited facilities and ID generation   at Tomawis Building, Poblacion
for members in the area. According        I, Parang, Shariff Kabunsuan and
to Pendaliday B. Beda, Division           can be reached at (064) 4250204.

April 2009                                                                                       Feel Health / Volume I, No. 02
    Benefits
Development




 Tubex Still
 Compensable
 By Kristine D. Besmonte


 While contracting typhoid fever           by the faeces or urine of infected        discovery in the field of medicine.
 is in itself a life threatening           people. However, it is also closely
 illness for anyone, children and          associated with poor hygiene, lack of     What is Tubex?
                                           clean drinking water and inadequate       Tubex is a rapid serologic procedure,
 elderly alike are warned to be
                                           sanitation. Symptoms usually develop      found to be comparable in sensitivity
 extra vigilant against its severe
                                           1-3 weeks after exposure, maybe mild      and specificity, as well as in distributor
 complications following an
                                           or severe, which includes high fever,     price, with other serologic tests for
 infection.                                malaise, headache, constipation or        diagnosing typhoid fever. It is a
                                           diarrhea, rose-colored spots on the       diagnostic test for detection of typhoid
    Although typhoid fever has             chest and enlarged spleen and liver.      fever, a disease caused by Salmonella
 practically disappeared from              The most frequent complications           typhi. In about 10 minutes, patients
 industrialized countries, it remains a    include gastro-intestinal bleeding        suspected of typhoid can easily be
 serious public health problem. In fact,   and intestinal perforation, severe        determined. It is as affordable as
 each year it affects about 12.5 million   neurological forms such as mental         Typhidot, the one commonly adapted
 persons each year. In the Philippines,    dullness, stupor, delirium, and shock.    for detection of typhoid.
 199 cases of this type of illness was     Illness can last for several weeks and        Reimbursement for Tubex falls
 reported in January 2008.                 even months.                              under “X-ray and Laboratory” and
                                                                                     is compensable only for inpatient
 Disease Burden.                           Vaccine.                                  hospitalization. Recognizing the
 Typhoid fever is a bacterial disease      Typhoid fever can be treated with         importance of this procedure,
 caused by Salmonella typhi. It is         antibiotics. In the Philippines,          PhilHealth through its resolution,
 transmitted through the ingestion         Typhidot test and Tubex are the           maintains that Tubex is still
 of food and drink contaminated            most popular, the latter being a recent   compensable.


 Feel Health / Volume I, No. 02                                                                                    April 2009
                                                                                                   Benefits
                                                                                                   Development


 PhilHealth Benefits
 for Professional
 Fees Up By 40%
 by Pinky G. Aragones

Starting January 1, 2009, PhilHealth has increased by up to 40 percent
its benefit payment rates for its accredited professional health care
providers who have equipped themselves with additional, appropriate
trainings that will translate to better services to its members.
    Through its newly launched            who have already completed their
tiered payment scheme, PhilHealth         residency training but are not yet
aims to provide incentives to its         specialty board certified. They have
partner physicians particularly those     accreditation codes 1501 to 1503 and
performing surgical procedures and        1601 and their fees shall be based on
other RVU services with assigned          a PCF 20% higher than the baseline
Relative Value Unit (RVU).                PCF or at P48/RVU. Theirs is the
    The RVU is a unit of measure          second tier of the scheme.
used by PhilHealth in determining             Doctors belonging to Groups 2 and
the relative complexity of surgical       3 shall have a PCF 40% higher than       recognized by the PMA (Group
procedures in its Relative Value          the baseline PCF or at P56 per RVU.      4 with accreditation code 1400)
Scale. It is multiplied by the existing   This is the third tier which entitles    shall receive additional 40% of
peso conversion factor (PCF) set by       fellows and diplomates of specialty      the computed benefits. Using our
PhilHealth to compute benefit for         societies recognized by the Philippine   example on appendectomy, the
professional fees.                        Medical Association (PMA) and with       compensation for anaesthesiologists
                                          accreditation codes 1201 to 1313.        based on the baseline surgeon’s fee of
                                                                                   P4,000.00 shall be paid as follows:
                                          Sample computations                      Group 1        =      P1,200
                                          For a simple appendectomy                Group 5 & 6 =         P1,440
                                          procedure with an RVU of 100 and         Group 2 & 3 =         P1,680
                                          a baseline PCF of P40, PhilHealth
                                          will pay the following amounts to the    From the above illustration, it really
                                          surgeon:                                 pays to continue updating one’s
                                          Group 1 (1st tier) = RVU 100 x P40/      knowledge and learning new skills
                                          RVU = P4,000                             and technologies. Keeping abreast
                                          Group 5 & 6 (2nd tier) =                 with the times is one sure way
                                          RVU 100 x P48/RVU = P4,800               too to remain in the competition.
So, how it does work?                     Group 2 & 3 (3rd tier) =                 In recognition of the accredited
Following the Claims Code Group,          RVU 100 x P56/RVU = P 5,600              doctors’ concern to render their
doctors are classified into three                                                  services to where they are needed
clusters: Group 1 is composed             Accordingly, doctors who provide         most, PhilHealth shall also provide an
of general practitioners with             anesthesia service will also benefit     additional 10% incentive to doctors
accreditation code 1100 and with          from the tiered payment scheme.          working in areas with limited health
no hospital training. Professional        Those who completed their                personnel.
Fee (PF) payouts for this group will      residency training (Groups 5 and            PhilHealth Circular 22, series of
be based on baseline PCF currently        6) shall receive additional 20% of       2008 however, reiterates that the rule
pegged at P40/RVU.                        the total computed benefits for          on tiered payment does not apply to
   Physicians in Groups 5 and 6,          anaesthesiologists. Fellows and          doctors’ payment for the daily visits
on the other hand, are doctors            diplomates of specialty societies        and management.

April 2009                                                                                  Feel Health / Volume I, No. 02
   Region in
      Focus




 Kawayan Festival 2009:
   Uniquely Koronadal
     by Hanah G. Naanep and Maria Sophia B. Varlez
                                                                               The celebration was in line with the
                                                                               National Arts Month.
                                                                                   In a rare display of new
                                     Perfect timing.                           creations, the craftsmanship of the
                                     The recently-concluded Area III           Koronadalans was showcased at the
                                     Work-Life Balance Program in              PROTECH Center that included
                                     Koronadal City had but one more           decorative lampshades, vases, wine
                                                                               holders, shelves, flyer holders, dining
                                     twist to an already fun-packed
                                                                               and garden sets, room dividers, and
                                     stay in the City of peace-loving
                                                                               an all-innovative indoor waterfalls set-
                                     people: the Kawayan Festival              up.
                                     2009 unfurled at the PROTECH                  The festival also featured kawayan
                                     Center just as the games were             games, and cultural shows. Himig
                                     about to close.                           Kawayan, or a musical fest using
                                                                               kawayan musical instruments will
                                     Why celebrate the flexible                soon be launched, according to
                                     kawayan?                                  PROTECH Manager, Manny Jumilla.
                                         For several years now, this city in       Geared to harness the vast
                                     the northern part of South Cotabato       potentials of South Cotabato and
                                     has been trying to promote the            match them with the interests and
                                     diverse products that can be derived      needs of investors, tourists and
                                     from this typical grass and boost its     locals alike, seminars and trainings
                                     chances for export to world markets.      on technological enhancement and
                                     The ultimate goal is to make bamboo       innovation of the kawayan processing
                                     one of the city’s major industries. In    industry were also organized.
                                     2004, in response to the unending         Environmental advocates, craftsmen,
                                     quest for home grown natural              artisans, entrepreneurs, skilled
                                     products that truly represents South      workers, investors, even mere booth
                                     Cotabato, gain prestige and foster        visitors were taught the optimal,
                                     the growth of the local Kawayan           creative and most economic uses of
                                     industry, Kawayan Festival was born.      kawayan.
                                         For nine days in February, various        Indeed, South Cotabato is a
                                     Kawayan products were showcased           haven of investment opportunities
                                     at the PRO-TECH or Investment             enriched by its culturally diversified
                                     Center in the City of Koronadal.          communities.

Feel Health / Volume I, No. 02                                                                               April 2009
Employer monitoring
made easy
Keeping tab of all the employers              Among the best features of the        first half of 2008 and by November,
in one’s area of jurisdiction,            AMS is the automatic generation of        Version 2.1.0 was released. While
particularly in a region                  billing statements, as well as regular    the AMS can be accessed by limited
as culturally diverse and                 reports that are not available in the     users, PRO 12 keeps the database
                                          PMAIS. These include the list of          accessible to the Service Offices
geographically challenging
                                          received employer reports per Service     through the Wide Area Network.
as Northern Mindanao is, is
                                          Office, transmittal lists used by the     The access is especially helpful to the
certainly a tall order. It is no          PMAC and SOs, pending remittance          SOs and to the PMAC where posting
wonder then that a new approach           reports, list of reporting, non-          of remittances and reports is done.
to monitoring various employer            reporting, remitting, non-remitting       At the same time, over-the-counter
accounts in Region 12 had                 and active employers. It can also         payments received through the SOs
to be conceived for a better              readily provide data on employers’        and PMAC are uploaded to the AMS
appreciation of the different             status, where membership, collections     using the OTCCS uploading utility.
data that were coming in.                 and benefit utilization are concerned.    Truly, the system makes frontline
                                              For employers seeking a renewal       servicing more convenient.
    Earlier, the Regional Office had to   of their business permits, the AMS            Thanks to the initiative of PRO
rely on the usual MS Excel program        generates a very important document       12’s Collection Section, to the
but posting the contributions of the      that can help facilitate the processing   system expertise of Mark Anthony
employers, including updating their       of their permits: the Certificate of      Ramoran and to the continued
profiles, soon became very tedious,       Good Payment Standing indicating          technical support of the ITMS, the
necessitating the design of a new         the employer’s posted reports and         AMS has gone a long way in keeping
system to efficiently address problems    remittances for a particular period.      the employer database of PRO 12
facing the Collection Section. Thus       This feature was introduced in            updated and reliable. (Special thanks to
was born the Accounts Monitoring          December last year.                       Hanah G. Naanep, PR Officer III, PRO
System.                                       The AMS was pilot-tested in the       12)

April 2009                                                                                   Feel Health / Volume I, No. 02
Membership
& Marketing




DFA Desk:
Still Serving OFWs
by Lalaine B. Betonio

                                 It was during the 3rd Anniversary    provides basic information service
                                 of PhilHealth’s Overseas Workers     to members and non-members alike.
                                 Program in March 2008 when           Among its clientele are OFWs and
                                                                      non-OFWs who spend hours lining
                                 the information/service desk
                                                                      up at the DFA counters for their
                                 at the Department of Foreign
                                                                      passport processing requirements.
                                 Affairs (DFA) in Pasay City was
                                 put up. As one of the busiest           Members and prospective
                                 government agencies providing        members may fill out, request
                                 frontline services to Filipinos      for or file their membership
                                 leaving the country either on        application documents at the
                                 a leisure trip or for work, the      infodesk. An average of 60 clients
                                 DFA was a natural choice for         are being attended to by PhilHealth
                                 a PhilHealth infodesk. Here,         staffmembers daily. About 10 to 20
                                 hundreds of Filipinos troop          percent of the inquiries received by
                                 daily to apply or renew their        the desk pertain to OFW concerns
                                 passports.                           while the rest are questions on the
                                                                      Employed Sector and the Individually
                                    The DFA-PhilHealth desk is        Paying Program. The infodesk is
                                 located at the ground floor of the   open from 8:00 a.m. to 5:00 p.m.
                                 Passport Processing Center and       Mondays to Fridays.


Feel Health / Volume I, No. 02                                                                   April 2009
                                                                                                   Members’
                                                                                                   Concerns


Multiple deductions
from multiple
employers
by Glomeda C. Pactores


MEMBERS who are into multiple
employments often wonder
whether or not they are entitled
to multiple PhilHealth benefits
since premium contributions
are being deducted by each
and every employer where their
services are officially engaged.          monthly premium contribution                 Both situations also require that
                                          exceeds the maximum premium              the overpayment in PS was incurred
    Who are these members? They           rate in the prescribed premium           only upon effectivity date, i.e., from
are those engaged in two or more          contribution schedule may avail          January 2009 onwards and the period
professions, just like a hardworking      themselves of any of the following       covered for adjustment should have
employee from the government or           options, whichever is applicable:        been posted both in PhilHealth
private sector and likewise working as                                             Member Accounts Information
a part-time instructor in a university.   One-time Adjustment of                   System (PMAIS) and Treasury
They can be the doctor serving in         overpayment in personal share            Database. The overpayment in PS
two or more hospitals, or they could      * The requesting member is               should also be due to the member’s
be the service crews by day and call        separated from employment from         multiple employment.
center agents by night. These formal        all of his/her employers;                  To request for either an adjustment
preoccupations result to different        * The aggregate monthly premium          or a refund, the member must simply
employers who are required to remit         contribution exceeds the maximum       submit the following requirements
to PhilHealth the prescribed premium        premium rate in the prescribed         to the Collection Section (ColSec)
contributions of anybody under their        premium contribution schedule          of any of the PhilHealth Regional
employ. These employers also remit          which resulted in the overpayment      Offices:
their counterpart contributions to          of monthly personal share (PS);        a. Properly filled-out request form or
PhilHealth.                               * The overpayment in the personal           letter requesting for adjustment/
    But what if a member pays               share shall be reflected as advanced      refund of overpayment in personal
more than the maximum total                 payment of NHIP premium in                share;
monthly contribution as prescribed          the Individually Paying Program        b. Copy of any two (2) valid photo
by the premium schedule? Can an             (IPP) pursuant to the provisions          ID’s such as SSS ID (ATM), GSIS
adjustment in his contributions, or         of Office Order No. 48 s.2008             E-Card, Passport, Company ID,
a refund of his overpayment, be             re: Guidelines for the adjustment         etc.;
possible?                                   of premium payment records of          c. Copy of Employment Contract
    To address these issues, PhilHealth     NHIP Members                              reflecting monthly income and
came up with Circular No. 5 series of                                                 status of employment from each
2009 that clarifies the implementing      Refund of overpayment in                    employer
guidelines on the premium payment         Personal Share                           d. Certificate of Employment
of all members of the National            * Member is sixty (60) years old            reflecting monthly income and
Health Insurance Program (NHIP)             and above and has paid the                status of employment duly signed
with multiple employment.                   required 120 monthly premium              by the employers, or
    Members engaged in multiple             contributions; and                     e. Other documents as may be
employments whose aggregate               * Member is no longer employed.             required by ColSec of PROs.

April 2009                                                                                  Feel Health / Volume I, No. 02
Accreditation
     Matters




 Accreditation a
 Must for Chiefs
 of Hospitals,
 Medical Directors
 and Hospital
 Administrators
 by Faudia H. Subillaga


 CHIEFS of hospitals, medical              normally plan, direct, implement and        PhilHealth now has a total of
 directors and hospital adminis-           control the operations and services      3,460 accredited IHCPs including
 trators who are physicians must           of the hospital. They also sign the      ASCs, FSDCs, OPB Providers,
 first be accredited before their          PhilHealth claim forms in behalf of      Maternity Care Clinics and TB/
 health care institutions can be           salaried physicians in government        DOTS Centers. Despite the migration
 accredited.                               and private training hospitals. “It is   of health care professionals, a total
                                           mandatory to all the hospital heads      of 21,143 professionals are now
    This was thoroughly emphasized         to apply for PhilHealth accreditation    PhilHealth-accredited nationwide
 by Dr. Rey B. Aquino, PhilHealth          as medical professionals before they     including general practitioners,
 President and CEO in one of the           can even apply for their hospital        medical specialists, dentists and
 episodes of “PhilHealth, Hataw sa         accreditation,” adding that it should    midwives.
 Serbisyo!,” on Radio DWIZ 882             be incumbent upon these
 KHz-AM.                                   doctors to be accredited
    Noting that almost 82 percent          professionals first.
 of Medical Directors in accredited           In the same episode,
 facilities have not applied for           Aquino also reminded
 accreditation, PhilHealth issued          accredited health care
 Circular No. 21, series of 2008           professionals to file for
 making their accreditation a pre-         the renewal of their
 condition prior to the accreditation      accreditation four (4)
 of the health care facilities that they   months prior to the
 represent. These facilities include       expiration date of their
 hospitals, Ambulatory Surgical Clinics    current accreditation
 (ASCs) and Free Standing Dialysis         to avoid any problems
 Centers (FSDCs).                          concerning claims in the
    These hospital authorities             future.



 Feel Health / Volume I, No. 02                                                                                April 2009
                                                                                                 Legal
                                                                                                 Speak

                                                                                 of the corporation…”
                                                                                     In such cases, members may
                                                                                 file their complaints with any of
                                                                                 PhilHealth’s offices nationwide. After
                                                                                 thorough investigation has been
                                                                                 made, the FFIED files complaints
                                                                                 against erring health care providers
                                                                                 based on prima facie evidence.
                                                                                     In order to minimize, if not
                                                                                 totally eradicate the incidence of
                                                                                 HCPs refusing to deduct the benefits
                                                                                 at point-of-service, PhilHealth has
                                                                                 launched intensive information
                                                                                 and education campaigns directed
                                                                                 to both members and healthcare
                                                                                 providers. As of this writing, a
                                                                                 series of Fora are being conducted
                                                                                 by the PhilHealth Training Institute


Refusing to
                                                                                 in the National Capital Region to
                                                                                 provide intensive training to hospital
                                                                                 representatives on different business

deduct Benefits:                                                                 processes as well as updating them on
                                                                                 new PhilHealth policies, with special


Are HCPs Liable?
                                                                                 emphasis on how they can effectively
                                                                                 facilitate member claims right in the
                                                                                 hospital level.
                                                                                     With teamwork and proper
by Pinky G. Aragones                                                             coordination among members,
                                                                                 healthcare providers and PhilHealth,
                                                                                 Mrs. Madrid’s case will hopefully be
Furious. This was the reaction         benefits, doctors claiming member’s       history.
of Mrs. Madrid , a 65-year-old         refund for professional fees and
mother, when the hospital              solicitation of patients.
refused to deduct her PhilHealth           Healthcare providers are liable
benefits from the total hospital       if they refuse to deduct or if
charges due to her son’s cataract      they under-deduct the PhilHealth
                                       benefits due the member before
extraction procedure. The
                                       discharge from the hospital. This
hospital staff advised her to
                                       is a violation of Section 149 of the
directly file her claim with           National Health Insurance Act of
PhilHealth for reasons she             1995 as amended, citing “Failure
herself could not understand.          or refusal to give benefits due to
Thinking that the hospital staff       qualified members/ dependents” and
was a PhilHealth employee, she         Section 153, Breach of Warranties
scrutinized how red tape in            of Accreditation. As stated in the
government works.                      Warranties of Accreditation Item 2.1,
                                       a health care institution “….shall,
   Mrs. Madrid is not alone in her     in the course of its participation
predicament. In fact, PhilHealth’s     with the National Health Insurance
Fact Finding Investigation and         Program by virtue of its accreditation,
Enforcement Department (FFIED)         comply with the provisions of the
has been receiving a number of         National Health Insurance Law (RA
complaints against healthcare          7875), its Implementing Rules and
providers such as under-deduction of   Regulations, all administrative orders


April 2009                                                                                Feel Health / Volume I, No. 02
      Info
  Campaign




                                 by Jonathan M. Yao


For years, PhilHealth has been a            Annie Rentoy. For about a year, the
partner of UNTV 37 in advocating            Public Affairs Department handled
the importance of social health             the guest coordination for the weekly
insurance. The partnership                  segments until the task was turned
started three UNTV locations                over to the NCR Group who
                                            now rotates the guests from
ago (first in Ortigas, then in
                                            the three NCR Branches.
New Manila and now along
                                            The segment airs
EDSA in Quezon City) and by all
                                            Thursdays from 4:30
indications, the linkage will go a          to 5:00 p.m.
long way more.                                 Today, another
                                            free segment has
    As early as May 2005, PhilHealth
officers have already started guesting
on the show. Dr. Francisco T. Duque
III, former PhilHealth President
and CEO and now Health Secretary
guested on “What’s up Doc?”, an
early morning show hosted by Dr.
Ed Bien and Lyn Perez. Then,
other officers followed, sharing vital
information on PhilHealth operations
through “Kaka in Action” hosted by
Daniel Razon and Atty. Claire Casto.
    Finally, in February 2007, upon the
initiative of Vice President Rodolfo
M. Balog of the NCR Group, the
UNTV offered PhilHealth a weekly
segment to discuss different concerns       been granted to PhilHealth, this time,       Calls and text inquiries are
of members, gratis! The segments            on Tuesdays at 7:30 a.m., within the     answered LIVE by the guests in
were aired within the “Kaagapay”            program “Good Morning, Kuya!”.           both segments. The questions focus
program hosted by Rolly “Lakay”             No less than Daniel Razon interviews     on membership registration, claims
Gonzalo, Dr. Mandy Saguin and               the PhilHealth officers.                 availment, declaration of qualified
                                                                                     dependents, and payment concerns.
                                                                                     Most viewers of the programs are
                                                                                     professionals, overseas workers, self-
                                                                                     employed members, elderly and even
                                                                                     housewives. With UNTV 37’s wide
                                                                                     global reach, (it is accessible through
                                                                                     www.untvweb.com), the PhilHealth
                                                                                     segments are certainly viewed and
                                                                                     listened to in the different continents
                                                                                     of the world particularly in North
                                                                                     America, Europe and Asia.

Feel Health / Volume I, No. 02                                                                                    April 2009

						
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