At least, 150 participants attended the 3-day Benefits Administration – Stakeholders’ Forum at FB Hotel, City of Koronadal last September 23-25, 2014.
First day of the 3-day fora was participated by lying-in clinic owners and TB-DOTS operators; second day by the representatives of infirmaries, free standing dialysis centers and ambulatory surgical clinics and third day by the representatives of Levels 1, 2 and 3 health facilities.
“Please help us achieve our goals of providing financial risk protection for all. Let us work together for universal health care. This is not our program. This is the program of every Filipino that is why, all of us needs to take care of this. Philhealth needs everybody’s support for the sustainable implementation of its program,” Acting OIC, Regional Vice President and Management Services Division Chief, Merlie C. Sabug said.
Common issues raised were on the guidelines of claim filings on Maternity Care Package, Newborn Care Package, rules in filling out Philhealth Benefit Eligibility Form (PBEF), the No Balance Billing Policy and point of care enrolment for indigents.
Specifically, licensed doctors operating lying-in facilities verified if they could conduct IUD insertion without further training because as licensed OB-Gynecologist they have already undergone the same.
AQAS Head, Dr. Antoniette M Ladio approved the request provided they could present a copy of certificate during their training as OB.
They have also asked if the pre-natal services can be conducted in the residents of their clients especially those who are living in far flung areas.
Benefits Admin Section Head, Dr. Henry F. Manzares agreed provided the delivery must be conducted in their respective accredited facilities. “…you may bring the services to the community during Barangayan activities,” added Ladio.
They have also requested Philhealth to allow their facilities to adopt the point-of-care enrolment to cover non Philhealth members.
“To date, only government hospitals are allowed but we hope to expand the program if that will help attain our Universal Health Care Program,” Health Care Delivery and Management Division Chief, Dr. Edson F. Pama said.
Information Technology Management Services Head, Claudette A. Canlas on the other hand, clarified the inconsistent reply of yes and no of the portal on the issuance of PBEF for patients.
“Electronic portal hastened the process of benefits availment for members because it no longer requires them from submitting their member data record; however inconsistency of feedback by the system happens if several entries are logged at the same time,” Canlas said “…just bear with us when it fails due to traffic of information and low signal of the internet connection … hope to solve this issue in the near future,” she added.
The same problem on PBEF issuance was actually raised by the participants on the second day.
“Can we cancel, delete or edit our entries in the process of checking the eligibility of member prior to admission?” one of the participants asked.
Canlas replied that they are allowed only once during the verification process provided all data entered must be correct. “Ask the patient first about the veracity of eligibility or better send us your query through email to verify the validity of the member. This is why we keep on asking of your active email account and why we keep on reminding to check your mail from time to time,” she added.
OIC Field Operations Chief, Lorelie G. Bonilla requested them also to verify not only through the system but also through the Regional Office for the authenticity of information.
“The system may fail from time to time but take note that all over the Philippines, Region 12 ranks second in the number of turn-around time in processing claims of hospitals. In fact, from 60days, we have now reduced the number of processing days to 23 as of August and hope will be lessened soon,” Local Health Insurance Office Head, Nonito G. Bayaras added.
One facility owner lauded the efficiency of services assured by Philhealth and its noble intention of providing the No Balance Billing Policy which however according to him does not provide satisfactory services to the members.
“We are willing to grant the NBB because as private hospitals, we can guarantee to provide not only quality of care but sure availability of laboratory services and drugs and medicines to our patients. What is Philhealth doing to these government facilities abusing members’ benefits?” he verified.
Manzares replied that Philhealth has its anti-fraud monitoring team in-charge of checking out those hospitals in the watch list. “Those who are violating are strictly monitored and they are already warned… On the other hand, private facilities may also adopt their own version of the No Balance Billing Policy at their initiative. Just send us your Letter of Intent. We will take charge of your incentives,” he added.
Sharon Rose Ysmael representing the Legal Support Services Unit (LSSU) also said that the LSSU has its anti-fraud team who are constantly monitoring hospitals in the watch list.
The increasing number of teenage pregnancy which restricts infirmaries from providing the maternity care package was likewise taken up.
“We can’t afford to risk the lives of teenage mothers. That is why we recommend them to deliver their babies in the hospital.” Manzares said.
In the forum for Levels 1, 2 and 3 facilities, the common concern of government hospitals in implementing the point of care enrolment is the multiple enrolment of members in different membership categories.
“Others are actually enrolled as self-employed, however failed to pay their premium. This duplicates their membership with us and cause the denial of our claims,” one rep said.
It was clarified that as long as the member is enrolled and was paid for his premium prior to submission of his claim, he is covered and the claim filed by the hospital for him shall be paid.
The common problem raised by private hospitals on the other hand is on the issuance of PBEF which delays their transaction of admitting the patient and filing claims for reimbursement.
“Is there a way that other than checking on the eligibility of members, can we also check for their 45-day admissions to determine whether they are still allowed to avail of the benefit or not?” asked one rep.
Canlas replied that for now, PBEF can only provide the status of membership and contribution status which determines benefit eligibility of the member. “As to the number of admission our member has already incurred is something that we are looking forward to be included by the system soon,” she added.
To avoid further denial of claims, Ysmael reminded all the participants to follow all the guidelines, comply with the requirements needed for claims processing and submit them to Philhealth less than 60days after patients are discharged.
“Rest assured that all issues and concerns presented during the forum are well noted. Regional level matters shall be taken charged by the PRO and other matters requiring policy interventions shall be sent to the Central Office," Bayaras concluded.
In line with the coming PhilHealth 20th anniversary, Bonilla invited all the participants to join another round of PHilhealth Run on February 15 next year. (hanah g. naanep)