DAHIL UNA SA AMIN ANG INYONG KALUSUGAN…

Nais naming bigyang linaw ang ilang mga bagay patungkol sa alegasyon ni Dr. Rustico Jimenez, Pangulo ng Private Hospital Association of the Philippines Inc. (PHAPi) ukol sa diumano’y hindi nababayarang claims ng kanilang member-facilities, bagay na nagdudulot ng agam-agam sa mga miyembro ng PhilHealth.

DAHIL UNA SA AMIN ANG INYONG KALUSUGAN…
Ospital Diumano’y utang namin Aktwal na estado ng claims (as of May 21) San Juan de Dios
Hospital P15M Walang backlog, Calamba Doctors Hospital P15M 719 claims ay ibinalik sa ospital o na-deny;halaga: P6M Western Visayas Medical Center(pampublikong ospital) P13M Walang backlog,Gingoog Sanitarium Misamis Oriental P7M Kasalukuyang pinoproseso, Ciudad Medical
Zamboanga Hospital, P6M Walang backlogVirgen Milagrosa Hospital,San Carlos City P6M Walang backlog “De Vera Hospital” sa Bulacan P5M Walang “De Vera Hospital” sa Region 3, San Pablo Doctors Hospital P4M. 542 claims ay ibinalik sa ospital o na-deny;halaga: P4M Alterado General
Hospital, Davao P4M Iisang claim lamang ang isinumite ngayong taon; halaga: P15,000 St. Camillus Hospital,Davao Oriental Delayed payments magmula January Humiling ng advance payment para sa Marso at Abril 2014, subalit hindi pinagbigyan dahil ito ay napapaloob pa sa 60 araw na processing period na itinakda ng batas.

Una, may nakatakdang 60 araw mula sa araw na matanggap namin ang claim upang ma-proseso at mabayaran ito. Kapag lumampas na sa 60 araw at hindi pa ito nababayaran, ito ay maituturing na ‘backlog.’Narito ang status ng mga claim reimbursements sa mga ospital na binanggit sa isang media interview ni Dr. Rustico Jimenez noong May 21: Maraming salamat po at nawa ay patuloy ninyo kaming suportahan sa aming hangaring “Bawat Pilipino, miyembro. Bawat miyembro, protektado. Kalusugan natin, segurado.”

Narito naman ang maaaring mga dahilan ng pagkaantala sa pagpoproseso ng claims ng mga ospital:

• Return-To-Hospital (RTH) o ibinalik sa ospital dahil may kakulangan sa mga dokumento

• Refiled o muling pagsusumite ng claim matapos makumpleto ang mga kinakailangang      

dokumento

• Denied - lumampas sa itinakdang 60 araw ng pag-file ng claim o kaya ay may eligibility issues

• Iniimbestigahan alinsunod sa aming quasi-judicial authorityWalang batayan ang sinasabi ni Dr. Jimenez na kami ay may utang sa 600 member-hospitals ng PHAPi na umaabot sa P600
milyon. Sinisiguro namin sa mga ospital na ang mga good claims na natanggap namin hanggang ika-30 ng Abril 2014 ay mababayaran bago matapos ang Hunyo 2014. Tinitiyak din namin na may kaukulang pondo para sa pagbabayad ng claims ng mga miyembro, at nananatili ang aming pondo sa halagang P116 bilyon.

• Ayon kay Dr. Elmer Pedregosa, Administrador ng Iloilo Mission Hospital at Presidente ng PHAPi Western Visayas, hindi dapat mangamba ang mga miyembro ng PhilHealth sa Region VI dahil sila ay walang nararanasang pagkaantala sa pagbabayad ng PhilHealth.
•

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