Alternatives for Availment of PhilHealth Benefits - Direct Filing

Did you know that there are two ways which we could avail of your PhilHealth benefits? You already know the most common method which is for the hospital and/or doctor to immediately deduct your PhilHealth benefits from their bills and then later the hospital and/or doctor would file a claim to PhilHealth reimbursing the amount deducted from your total charges. The not so common alternative is to pay the hospital and doctor's bill in full and then directly file the claim with PhilHealth - direct filing.

In practice, the direct file method is preferable if you are capable of paying your bills in full. This is because you can maximize the amount that you can reimburse from PhilHealth though it would still take the same processing time of 3 months before you can expect to receive a check from PhilHealth.

Do you know that in some cases, hospitals and doctors are not actually deducting the maximum amount of your benefit? This is a safety net for them as they are not certain if the medicines, procedures etc. will be slashed (reduced cost) or if you have fully used up your PhilHealth benefits. Then later they will reimburse the full amount from PhilHealth meaning they will reimburse more than they actually deducted from your bill.

How will you know that what they deducted from your bill is less than their actual reimbursement? You can validate this through the Benefit Payment Notice (BPN) that will be mailed every time a claim or request for reimbursement under your record is filed. This notice illustrates or details the amount paid to the hospital and/or doctor. You can use this to compare the amount that was deducted from your bill using the Statement of Accounts provided by the hospital and the actual amount the hospital/doctor received from PhilHealth as reflected in the BPN. You will know if the doctor or hospital maximized their deduction if the amount received matches with the deduction from your bill.

Now, what happens when the amount received from PhilHealth is more than the amount that was actually deducted from you? You can go to the hospitals to get the remaining amount or in cases when the hospitals have already returned the excess amount to PhilHealth, you can go to PhilHealth to claim your benefits. PhilHealth usually announces the claiming of refunds through a publication. The links below will take you to more information for this case.

• SunStar "Aquino: Keep those billing statements" contains additional guides.
• PhilHealth Circular No. 42, s-2009: Revised Provision for the Recovery and Disposition of the Unclaimed Refunds from Accredited Institutional Health Care Providers (IHCPs)
• PhilHealth Circular No. 14, s-2007: Granting of Reward for Information Leading to the Discovery and Recovery of Unclaimed PhilHealth Reimbursements

Take note, you should always have a copy of the Statement of Accounts and official receipts from the hospital and doctor and compare it to the mailed Benefit Payment Notice (BPN). Make sure that you have an updated member record, particularly your current address so that you will receive the BPN in your mailbox.