Charging Doctor’s Fee To PhilHealth Benefit

This is my third article in a series of blogs about our son’s hospitalization and surgery to remove his gallbladder due to stones in it. The first one is about the time frame in which the pain due to gallstones was first felt by our son, their detection by ultrasound examination until their eventual removal by surgery. Our struggle to raise the money to pay the hospital bills and doctors’ fees together with the unexpected PhilHealth benefit coming to the rescue was the subject of our second blog on the matter.

I mentioned in my article before this one that the PhilHealth Special Benefit Package which we did not expect to be availed by our son was a manna from heaven. Together with the money we have raised, we thought that our son son could finally go home but that was not the case. The current practice on how the member’s benefit from PhilHealth Case Rate Package is applied to his hospitalization expenses made a big difference on how much cash we need for our son to be discharged.

Our son’s hospital bill was PhP41,327.00 while the professional fees charged by the doctors amounted initially to PhP75,500.00 for a total of PhP116,827.00 when the discharge order was issued by his doctors on a Friday noon. With a total deposit of PhP70,000.00 and the PhP31,000.00 PhilHealth benefit, our balance to pay should have been PhP15,827.00 only.

After consulting with our other children, we knew that we cannot raise anymore cash so I seek the approval of our son’s surgeon to authorize the hospital cashier to accept my 15-day post-dated check (PDC) in the amount of PhP20,000.00 as part of our payment for the PhP55,000 that he is charging as professional fee for him and an assistant surgeon. I then approached the hospital billing section with only my checkbook on-hand and the belief the with the surgeon’s approval to accept my PDC, our son can already go home that Friday afternoon based on my own computation.

To my surprise, the lady in the hospital’s billing section handed me a computation sheet showing that I need to pay PhP8,227.00 more in cash aside from the PhP20,000 PDC to settle our son’s account. The figures were very different from what I thought was an excess of PhP4,173.00 (20,000 – 15,827) after the surgeon’s approval to accept my PhP20,000 PDC.

Not satisfied with the explanation of the billing clerk on how she made the computation of our bill, I went to an office in the hospital to ask the PhilHealth representative how the PhP31,000 benefit under its Case Rate Package for Cholecystectomy (surgical removal of the gallbladder) is charged. He explained that the 60% of the benefit is chargeable to hospital bill while the 40% of it is for the surgical team’s professional fee. PA billing services help you reduce expenses and increase income, their service pays for itself.

Well, it seems all right until he told me that the doctor’s share of the member’s case rate benefit is charged on top of the professional fee he declared on our bill. Worded another way, the doctor’s fees for medical and surgical cases covered by Case Rate Packages is always net of PhilHealth benefit granted to a member. This term or condition is not stated in PhilHealth circulars and I feel we were shortchanged by this deal between doctors and state health insurance agency. And maybe, the BIR too. What do you say?