PhilHealth members told to file complaints

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BAGUIO CITY – The Cordillera office of the Philippine Health Insurance Corporation (PhilHealth-CAR) called on members who have issues and concerns on their hospital bills to formally file their complaints with the agency to allow the conduct of full-blown investigation that would cause the eventual removal of the accreditation of the health facility from the agency when warranted.

PhilHealth-CAR Acting Regional Vice President Dr. Dominga A. Gadgad, however, stated that such complaints must be substantiated with substantial pieces of evidence to allow investigators to appreciate the validity of the same that will pave the way for the smooth conduct of the warranted investigation.

The PhilHealth-CAR official claimed that the agency has been made aware of a number of complaints from members on their billings from the different hospitals after having undergone confinement due to treatment and medical procedures for their illnesses, especially the Corona Virus Disease (COVID) 2019, but they have yet to receive complete formal complaints on the same for the conduct of the required investigation on the matter.

According to her, once there are lacking documents on the claims being submitted by hospitals, especially on COVID-19, the same is immediately being returned back to the hospital management for the completion of the requirements and that the same will not be processed until such time that the pinpointed lacking documents shall have been completed.

Gadgad pointed out that the agency is trying to effectively and efficiently manage its funds for the same to be utilized only for the payment of legitimate claims because the money came from the hard earned contributions of the members who were able to pool their resources for the provision of the prescribed benefits to those that need the same.

She stipulated that the complaints being lodged by the members is most welcome to prevent the agency from processing and paying inappropriate claims that might have an impact on the agency’s funds previously earmarked to pay the legitimate claims of health facilities where members have been treated for COVID-19 or other illnesses.

She disclosed that COVID patients being confined in private and public health facilities for them to be provided with the appropriate treatment should not be required to pay a portion of their bills upon their discharge because of the available packages that had been put in place by the agency to ease the burden from the members on having to shell out their hard earned money after having been impacted by the ongoing pandemic.

Among the actions being undertaken by the PhilHealth upon the submission of claims by the hospitals is to assess the same on their completeness prior to proceeding with the prescribed procedures and if found to be questionable, the claims are either denied for valid reasons, referred to the legal office of the agency or referred back to the hospital for the completion of lacking requirements and data on the forms.

She emphasized that the complaints that will be submitted to the agency will be given immediate attention, especially when it is supported by conclusive evidence, to ensure that the money of the members will be spared from being unnecessary spent.

By Dexter A. See

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