HMOs ‘to pay 50 percent hike in doctors’ fees, not patients’

IT IS not doctors raising their professional fees (PF) rates with health maintenance organizations (HMOs), but HMOs allowing doctors to charge 50 percent more.

This was the clarification made by Dr. Karen Caudor, Philippine College of Physicians (PCP)-Central Visayas chapter president, after information about doctors allegedly charging patients more during the coronavirus disease 2019 (Covid-19) pandemic made the rounds on social media.

"The HMO(s) offered those rates. It's their decision. (The) national PCP had a memorandum of agreement (MOA) with HMOs. The rates are stipulated in the memo," she said in a text message to SunStar Cebu on Saturday, July 4, 2020.

On Friday night, July 3, former Government Service Insurance System president Winston Garcia brought to light on Facebook his disappointment over a PCP advisory informing members about the increase of their fees by 50 percent amid the health crisis.

On his post, Garcia said he was "disheartened" by the PCP advisory as it was not only bad timing but "cruel and insensitive having been issued in the midst of crisis of tremendous sufferings" by Filipinos.

"Look at how hospitals and their doctors have been overcharging poor and hapless patients with exorbitant medical exams and fees under the guise of protection against the coronavirus," reads a portion of his public post.

Dr. Bernard Chiew, chairman of the PCP national committee on external affairs, said the increase in professional fees will be at no extra cost to patients as it will be shouldered by HMOs, which are the Association of Health Maintenance Organizations Inc. (Ahmopi) and the Philippine Association of Health Maintenance Organizations Companies (Pahmoc).

Ahmopi and Pahmoc are health insurance companies which are third-party payors for health services availed of by patient-members.

In their letters to the PCP, both HMO organizations recognized the risks and the additional expense doctors had to incur for their personal protective equipment when managing patients, Chiew said.

To support the PCP, they raised the PF rates. Hence, the PCP advisory to doctor-members, he said.

In a follow-up FB post on Saturday, July 4, Garcia said he believes these doctors are "missing the whole point."

He said being in the forefront of the fight against Covid-19 never justifies one or even an institution "to profit from it."

"Everyone of us, in one way or another, are also in the forefront in this fight. From the business establishments that have to close shop, to the many of us who have to stop working and earning a living for our families, are all involved in this fight against the coronavirus," he said.

"The only difference is, while the rest of us are carrying the heavy financial burden of this crisis, the medical community, particularly the doctors and hospitals are thriving from it," he said.

Chiew said the PCP and Ahmopi/ Pahmoc have had a MOA since 2009 (renewed every three years thereafter) which guides both parties as to their rights, privileges, responsibilities and PF rates in the management of HMO clients or patient-members.

As HMO members, he said, patients do not pay the PF of doctors. The HMOs do, similar to what PhilHealth Insurance Corp. and other private companies do, he said.

Attached to Garcia's post is a photo of the PCP advisory dated June 4 and signed by Dr. Maria Gina Nazareth, fellow of the PCP and president for 2019-2020.

The advisory states that the PCP and the Ahmopi and Pahmoc MOA participating members will have a 50 percent increase in their PF amid the Covid-19 pandemic.

It will take effect from June 1 to Sept. 1, 2020 for Ahmopi and from May 25 to Aug. 25, 2020 for Pahmoc. It may be extended until the state of public health emergency is lifted.

The advisory includes a table stipulating the adjusted PFs of physicians.

For instance, the PF for out-patient face-to-face consultation under MOA 2018-2020 is P400; during the Covid-19 pandemic, it will become P600.

For in-patient daily visits: (a) ward from P600 to P900, (b) semi-private from P750 to P1,125, (c) Intensive Care Unit or Critical Care Unit from P1,400 to P2,100, among others.

The advisory said Pahmoc’s PF rate for telemedicine consultation is P400.

These PF rates will apply to Covid and non-Covid cases. OPD face-to-face consults and teleconsults do not have PhilHealth Insurance Corp.'s component rates while other fees/rates are exclusive of the same.

The MOA with Ahmopi and Pahmoc will expire on Dec. 31. The PCP committee on external relations is negotiating with them to raise PF rates in the MOA renewal, it said. (WBS)


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