Monday, May 30, 2011

Are doctors or hospitals allowed to directly deduct PhilHealth benefits from their fees?

Yes, doctors or hospitals are allowed to directly deduct PhilHealth benefits from their fees, (assuming they are accredited). However, this is not mandatory, hence members have the option to pay in full the doctor's fees or hospital charges and then directly reimburse from PhilHealth.

The doctor and the patient should come to terms with the following:
  • Is the patient a PhilHealth member or dependent?
  • How much is the doctor's fee (if not a PhilHealth member)?
  • How much will be the PhilHealth deduction?
  • Will the member opt to directly file reimbursement or will the member allow the doctor or hospital for the outright deduction or availment of PhilHealth benefits?

Please note that in the real world, physicians sometimes charge differently depending on whether the patient is a PhilHealth member or not, and sometimes, the deductions representing the PhilHealth benefits made by the doctor or the hospital do not reflect the maximum possible amount. For this reason, check the Benefit Payment Notice (BPN) that you will be receiving, You may use this document to validate if the amount deducted by the hospital and doctor tallies with the amount they received from PhilHealth. If the amount they received from PhilHealth is greater than the amount they have deducted, then you may request for a refund from the hospital and the doctor. If the balance was returned to PhilHealth you may contact the PhilHealth Office near you.
    For other tips regarding availment of PhilHealth claims, you can read this blog post.

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