An Unexpected PhilHealth Benefit

When we learned that our 30-year old son had stones on his gallbladder in mid-August of this year and upon the advice of an internal medicine doctor that he consulted, we decided to have him register with Philippine Health Insurance Corporation (PhilHealth) as an Individually Paying Member (IPM). We did it with the hope that the surgery to remove his gallbladder would happen sometime in May 2014 when he would have paid at least nine (9) months of contributions and be entitled to a PhP31,000 benefit from PhilHealth.

What we hoped for did not happen because our son had his gallstones removed by surgery (cholecystectomy) in the first week of October when he had just paid for three (3) months on his PhilHealth contributions. Not having any other health insurance, we had to raise a substantial amount in cash to pay for the hospital bills and the professional fees of his doctors. He was given the clearance to go home on a weekend and payday is still five (5) days away so it became more difficult for us to raise the money pay for his bills.

Just when we are about to give up the hope that our son can be home by weekend, one other son emailed me a link to a news release saying ‘Informal sector’ may avail of Philhealth benefits after 3-month contribution effective on the Sunday just passed. An IPM is part of the informal sector mentioned in the news and this makes our son entitled to the PhP31,000 PhilHealth benefit. We consider this unexpected health care benefit as answered prayer from God Almighty.

It was Friday noon when we verified our son’s entitlement to PhilHealth benefit so we had to race against time to produce his Membership ID Card, Member’s Data Record and Official Receipts for payment of contributions. As if luck is evading us, we cannot locate the requirements in our house so I need to get them from the nearest PhilHealth Office.

I had to prepare an affidavit of loss and an authorization for me to secure copies of the required documents, have them signed by my son and notarized by a lawyer before I proceeded to nearest PhilHealth Office which is some 7 to 8 kilometers away. With the required documents on-hand, I had to be back to the hospital within office hours (up to 5:00PM) to have the PhilHealth Claim processed by the authorized personnel. I must admit that the procedures I did were very tiring for my 60-year body but I was able to do all of them within the time limit.

You might surmise that with the unexpected PhilHealth benefit and after the rush I did to avail of it, our trouble is already over. Not yet because there is something in the application of the PhilHealth benefit that caused a problem in computing how much we have to pay the hospital bill and the professional fees of our son’s doctors. Watch for the doctors’ practice in charging their professional fees against PhilHealth benefit that really confused me. This will be the subject of my next blog.

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