IN 2007 and 2008, we have issued Circular Nos. 22 and 11 respectively making the submission of official receipts and billing statements (or statement of accounts or any equivalent) as part of requirements in claims reimbursements of hospitals. This is to ensure that reimbursements reach the intended and rightful beneficiaries.
In doing so, PhilHealth will be more guided in paying hospitals of the services they have rendered as deducted from the actual hospitalization charges they billed PhilHealth patients. With the billing statements, PhilHealth will have a better way of knowing if there are still balances in benefits that members are still entitled to should there be any difference between the actual deduction made in the facility and the maximum allowable benefit based on the type of illness and hospital category.
With this requirement, both PhilHealth and hospitals can also prevent unwarranted accruals of unclaimed refunds of members. Ibig sabihin, matutulungan nito ang mga miyembro ng PhilHealth na malubos ang kanilang benepisyo at maiwasang maipon ang mga balanseng ito sa ospital.
Napakahalaga ng statement of accounts ninyo kaya ipinapaalala namin ang mga sumusunod:
1. Dapat na siyasatin o tingnang mabuti ang nilalaman nito bago pirmahan. Dapat ay maliwanag na nakasaad ang deduction ng benefits mula sa kabuuang hospital bill.
2. Kung authorized representative ang pipirma ay i-print ang pangalan, contact number at ang relasyon sa miyembro. Hangga’t maari ay kung sino ang pumirma sa Claim Form 1 ay siya rin ang dapat na pumirma sa statement of account.
3. Tingnan din kung nakalagda ang accountant o billing clerk ng ospital. Kung wala ay papirmahan na muna ito sa kanila.
4. Dapat na may kopya kayo ng statement of account at resibo opisyal bago lumabas ng ospital. Magagamit pa ng miyembro ang official receipt sakaling may ire-refund pa siyang iba pang benepisyo sa PhilHealth.
Keep your duly signed billing statements and official receipts after the confinement because these will serve as your reference in knowing whether you have availed of the right amount of benefits when you receive your Benefit Payment Notice or BPN.
If the actual deductions (made in the hospital) were less than the actual payments made by PhilHealth to the hospital, then you are clearly underdeducted. If this happens, we advise you to go back to your health care providers (bring your billing statements and ORs of course) to claim for the balance of benefits.
Dapat na malubos ninyo ang inyong benepisyo dahil ito po ay pinaghirapan ninyo.
Last call for IPMs in Albay
If you have relatives in the Province of Albay who are Individually Paying Members (IPMs) of PhilHealth, please tell them that we will still receive their 4th quarter 2009 payments until Friday, January 29, 2010. Thankfully enough, the eruption did not push through despite expert predictions of an imminent blast, saving Albay and neighbouring towns from further harm and losses. Although things already got back to normal, we will still receive their premiums for the said period in consideration of the inconveniences brought about by the Mayon situation.
They may pay their premiums at our Region V Office or at our service offices and accredited collecting agents in the region. The extension is also applicable to IPMs enrolled under the KaSAPI. Call our PhRO V office at (052) 481-5598; 820-0799 or 481-5580 for details.
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Mayroon ba kayong nais na itanong o talakayin sa column na ito? Mag-email sa rbaquino_ssp@philhealth.gov.ph para matugunan at mabigyang daan ko sa column na ito ang mga katanungan niyo tungkol sa inyong PhilHealth.