4b (responses)

11/29/2013 14:46:58 ARIESPOL ZABALA 4b [email protected]

BATANGASMEDICALCENTER Government 3 11/1/2013 11/30/2013 41 67 6 91 146 10 32 1172 849 849

Insisted to attachofficial receipt ofpurchasedmedicines andmedical supplies.

>Some of ourclients who wantedto be members ofPhilHealth wereasked to providesupportingdocuments andID's in theofficeeven if therewere nodiscrepanciesobseved. >Encountered a lotofmistakes/discrepanciesin their MDR. Mostin sponsoredmembers.

Many of our clientsare non membersand members butdon't havequalifyingcontributions. >We encouragedthem to pay thepremiumcontribution for theunpaid months forthe whole year of2013 toimmediately availof PhilHealthbenfits.

Somediscrepancies withthe names in thereceipt ofPhilHealthpremium paymentfrom somecollecting agents none

Sponsoredmembers arerestricted fromgetting medicinesfrom the hospitalpharmacy despiteof having aPhilHealth ID withvalidation period.The PhilHeathclerk refers theclient to PhilHealthCARES to providePCF1 even if themember hasdhis/her PhilHealthID. In otherwordsthe PCF! serves asa permit to getmedicines from thehospital pharmacy

NBB is still not fullyimplemented inthis hospital.Patient tends tobuy medicines andother medicalsupplies due toluck of suppliesand unavailabilityof medicines. none none none New Entry

11/29/2013 15:05:31

PAMFILORODOLFO III CUETO 4b

[email protected] Permanent

BATANGASMEDICALCENTER Government 3 11/1/2013 11/30/2013 41 69 3 94 146 14 35 1172 849 849

Some of ourclients who wantedto be members ofPhilHealth wereasked to providesupportingdocuments andIDs in the officeeven if there wereno discrepanciesobserved. Encounterednumerousmistakes anddiscrepancies inMember DataRecord (MDR),especially insponsoredmembers.

Many of our clientsare non-membersand members butdo not havequalifyingcontributions.> We encouragedour clients to paythe premiumcontribution for theunpaid portion ofthe year 2013, orfor the non-members, pay thewhole year.

There were somediscrepancieswiththe names of themember in thereceipt ofPhilHealthpremium paymentfrom somecollecting agents. None

Sponsoredmembers arerestricted fromgetting medicinesfrom the hospitalpharmacy despiteof having a validPhilHealth ID withvalidation period.The PhilHealthclerk refers theclient to PhilHealthCares nurses to toprovide PCF1even if themember hashis/her PhilHealthID. In other words,the PCF1 servesas a permit to getmedicines from thehospital pharmacy.

NBB is notobserved. N/A N/A None New Entry

11/29/2013 19:46:15 Jasmin Dane Alisna 4b

[email protected] Roving

Medical MissionGroup of Hospital Private 2 11/11 to 16/2013 2 5 1 2 1 0 0

A Formal sectormember(Employedmember) who hasbeen employed fora year is still underinformal sector inour data base.

AccreditedPhilhealthcontributing agents( e.g. WesternUnion) should beoriented regardingthe new policy ofthe implementationof the new IRRregardingretroactive/nonmember canstill pay the wholepremiumcontribution for2013 even it is thelast quarter of themonth.

Philhealth clerkassigningmembers/patients'attendingphysician to signthe back of theirCF2. They are notaccepting theclaim forms notunless its sign bythe attendingphysician.

Cares Post is notvisible to clients.No computerprovided for Cares. New Entry



Oriental MindoroProvincial Hospital Government 1 11/18 to 23/2013 0 8 0 13 9 9 0

Misspelled namesin the MDR ofSponsored/Indigentmembers in theirMDR.

-Late posting ofcontribuon of OFWmembers who paidthe premiumcontribution beforeleaving thecountry.

-Take home oralmedication are notcovered byPhilHealthpharmacy.-Supplies in theCSR arepurchased throughcash.-Philhealth clerkstill requiring formaeconomy sector (private employed)to provide proof ofcontribution fromthe employer tofully avail benefits.

No billingstatement providedfor dischargedPhilHealthmember. New Entry

11/29/2013 20:16:29 DONN RENE PEREZ 4b [email protected]

DON JUANMAYUGAMEMORIALHOSPITAL Government 2 11/1/2013 11/30/2013 268 313 5 222 297 37 571 585 543 543

Some of the non-members are stillhesitant to enrolluntil they validatedthe informationthrough us CARESand with the LHIOoffices.

Unavailability ofmedications thatare bought outsidethe hospital are theprimary concernsof the members. New Entry

11/30/2013 9:17:01 CHRISTIAN TEMPLE 4b [email protected]

METRO SANJOSE MEDICALCENTER Private 2

11/04 to11/09/2013 23 21 3 7 4 7 5

-The hospital is notstrict on ourPhilhealthmember'srequirements whenit comes tomembership, theyaccept supportingdocuments andare compliant toour policy. (circular50)-PCF1 fromCARES are beingaccepted as proofof membership

-Hospital followsPhilhealth's policyon 3/6 monthspremiumcontribution to allcases and areaware of the policythat helps non-members to availbenefits uponsuccessfullyapplying for aPhilhealthmembership andhaving paid theamount of thewhole current yearwithin theconfinementperiod.

-No issues- CARES are verymuch welcome inthe hospital

-Hospital havingproblems withclients who do notdeclare theirPhilhealth benefitsbeing exhausted.(some hospitalclaims got denieddue to benefitsexhaustion -benefits beingused less than 90days) - Private hospital

- Portal system inthe hospital is notupdated.(according to thehospital'spersonnel) New Entry


MADONAGENERALHOSPITAL Private 2 11/11 to 15/2013 14 11 2 4 2 5 0

-The hospital is notstrict on ourPhilhealthmember'srequirements whenit comes tomembership, theyaccept supportingdocuments.- When it comes toemployedmembership, theMDR should beupdated with thecurrent employerbeing printed in thehospital - AsCARES I suggestthem to still acceptthe requirementgranted that themember has theCF1 properlysigned by bothmember andemployer andwhen the memberhas other proof ofemployment.


-no issues-CARES arewelcome

-Members arebeing informed oftheir benefitsespecially whentheir case isassumed to fall oncase ratescategory.

- Private hospital- No PF on wardtype andsponsoredcategorymembership New Entry


METRO LIPAMEDICALCENTER Private 2 11/16 to 29/2013 116 39 5 9 2 8 11 11 338 324

- Personnel withgood customerservice makes adifference(Philhealth clerk inthe hospital)- Updated onPhilhealth's policy

-The hospital is notstrict on ourPhilhealthmember'srequirements whenit comes tomembership, theyaccept supportingdocuments andare compliant toour policy. (circular50)-PCF1 fromCARES are beingaccepted as proofof membership


- no issues- CARES are verymuch welcome inthe hospital- CARES areprovided withcomputer andinternetconnection.

- Hospital followsour benefitsamount and arebeing utilized.- Cases whenhospital are beingunderpaid(Pneumonia 2 isbeing paid withamount ofPneumonia 2) - Private Hospital New Entry

Timestamp First Name Last Name Region Email Address Status Hospital Covered Hospital Category Hospital Level Formal Economy Informal Economy Lifetime MembersIndigents (NHTS-

PR)Sponsored

Member Non-Member

# of Client's servedduring ward

classes, mother'sclass, opd

lectures,etc.

No. of Non-PhilHealth

member/dependentNo. of PhilHealth

member/dependent

No. ofmember/dependent

who are able toavail of the

benefitsHospital's Best

Practices Membership Contribution ACAsHealthcare

Provider Relations Benefits No Balance Billing All Case RatesOn site Point of

Care InternalPLEASE SELECT

ONE

11/30/2013 10:05:44 JEEMA BRINAS 4b


UNITEDDOCTORS OF ST.CAMILLUS DELELLIS HOSPITAL Private 2 11/25 to 30/2013 4 13 2 0 1 3 19

NOTE : I HAVENO AVAILMENTDATA FOR THEMONTH OFOCTOBERBECAUSE THEUNITEDDOCTORS OF ST.CAMILLUS DELELLIS OPENLAST NOVEMBER4, 2013.

1.RegistrationProcedure UnderOM 0257 s 2013.2.Correction independents Data3.Renewal ofMembership4.Qualifieddependent notdeclared inMember DataRecord.

1.Members losttheir premiumcontributionreceipt.2. ContributionPayment for year2014.

No issues andconcerns wereencountered.

Hospital staff isveryaccommodating toCARES nursesand no issues andconcerns wereencountered.

1.Hospitals havedifficultydeterminingbenefits formultiplemedical/surgicalcase rates.2.They also havedifficulty indetermining RVUand ICD 10 codes.3.Members did notavail the benefitsdue to incompletediagnosticprocedure neededfor the case rate.Like, Patient wasdiagnose withCVA 1, but she didnot undergoneneurologic exambecauseaccording to theclerk theNeurologist wasnot available.4.In cases ofdeath, Philhealthclerk has difficultyin deductingbenefits.They didnot deduct benefitsunder case type D.

Hospital did notimplement NBBbecause it isPrivate.

1.Board andlodging for CARESnurses assign farfrom theirresidence.2.Hazard Payallowance forCARES since weare doing roundsand werevery exposed todifferent diseases.3.CARES shouldhave an ICDtraining tomaximize theirfunctionality in thehospitals.4.Claim status andOFW validityperiod should beincluded onICARES.5. Payslip in everysalary. New Entry



Ma. estrellaGeneral Hospital Private 1 11/25 to 30/2013 6 7 1 6 0 4 0 81 773 773

-Sponsored/Indigentsbirthplace notindicated in themdr-multipledeclaration ofdependents-dependents fullmidle name is notindicated in themdr

-Member availedthe wrong benefit.Patient wasadmitted last July2013 and claim abenefit of P8000for DHF1. whemember receivedthe BPN this Octthe BPN statedthat PhilHealthpaid the hospitalthe amount ofP16000 for DHF 3;4. the hospitalreimbursed themember rightaway.-Patients arestaying in thehallway.-RTH claimsrequiring patientssignature arebeing forged bythe philhelathclerk. New Entry

11/30/2013 12:19:28 Datinguinoo Inah 4b

[email protected] Roving OMPH Government 1 11-4-9,2013 6 5 2 11 11 5 41 5 41 41

Having a separatePharmacy forPhilHealth andnon-PhilHealthmember. give a freehospitalization toindigenous group(mangyan) give a discount tonon-philhealthmember whocannot afford topay the full bill.

Mother in-lawdeclared asdependent,but itold himn that isnot valid. They are verythankful for ournew circular whichis only thedocuments of thebeneficiaries areneeded. Almost everyclients that i haveencounterd on thehospital hadapplied to bemember ofPhilHealth to availthe benefits.

Informing the nonphilhealth clientsthat to be able thebenefitsimmediately theyhave to be aIndividually payingmember and paythe whole yearpremium.

Dr. Cruz told methat we shouldhave computer tosupply the neededdocuments of theclients especiallyMDR

clients can availthe benefits but didnot maximize itbecause ofinsufficient supplyof medicines.

they practice theNo Balance Billingbut the clients stillhave a out-pocketexpenses onmedicines boughtoutside.

Assisting the clienton fillinh their CF1and PMRF Instructing themhow to correct thewrong data ontheir MDR told them toalways go first onhospital pharmacy having a specificteaching about thebenefits of being amember especiallyto those who arenon-PhilHealthindividual and indoing so,encouraging themto be a member .

Helping them ingetting and updatetheir MDR New Entry

11/30/2013 12:03:10 JANICE SANDAHAN 4b [email protected]

ROXASMEDICAREHOSPITAL Government 1 11/1/2013 11/30/2013 4 2 1 31 0 11 21 89 58 54

Some sponsoredmembers didn'tknow that theirphilhealthmembership wasalready renewed. IfI didn't verify itthrough ICARESthey won’t be ableto avail theirclaims. Also, somesponsoredmembers didn’tknow that they arein the list ofsponsoredmembers becausetheir philhealth ID’swere given only tothem 1 monthbefore theexpiration date ofthe validity period.

A doctor told methat as a CARES Ishould check thewritten finaldiagnosis of thepatient to knowwhether it iscompensable ornot. So that if it isnot compensablethey can change itto the nearestdiagnosis thatwould fit the caseof the patient and itwould be alreadycompensable. Isaid to that doctorthat it is not a partof the job ofCARES to do thatand it is notprohibited to dothat. Some staffdidn't give thepatient a labrequestimmediately uponadmission that’swhy although thecase of the patientis compensablethey can’t avail itbecause they don’thave laboratoryresult that willsupport theircases.

DifficultyunderstandingBPNs, especiallyfor those illiteratemembers.Memberscomplained that ittook them monthsbefore theyreceived theirreimbursementsince the hospitalstill waits from thetrust fund releaseby provincial office.Some membersdidn’t know thattheir dependentshave 45 daysbenefit allowance.They thought thatif one dependentalready use theirphilhealthavailment the otherdependents can nolonger use it.

The Sponsoredmembers are notoriented aboutCase Rates andNBB Policy uponadmission. TheNBB Primer is notvisible in any areaof the hospital.There is no freepotable drinkingwater instead; theyhave to buy at theNurses’ station orstores outside thehospital.PhilHealthmembers areforced to buy theirmedicine and othermedical supplies inthe cooperativestore since thehospital lacksmedical supplies.Members alsoneed to pay firstfor the laboratoryfees. New Entry

11/30/2013 12:25:31 Datinguinoo Inah 4b

[email protected] Roving OMPH Government 1 11-4-9,2013 6 5 2 11 11 5 41 5 41 41

11/30/2013 13:24:03 JOANNE JAVIER 4b [email protected]

MARTINMARASIGANMEMORIALHOSPITAL Government 1 11/1 to 15/2013 29 12 0 8 13 7 69

- Hospital clerk'swereaccommodating.- They wereupdated in newpolicies and alsoinformed in-patientand outpatientmembers about it.- We do morningrounds to checkrequirements andencourage Non-philhealthmembers to enrollto avail benefits.- They allowmembers to followup requirementsafter discharge tocomplete theneeded documentsbut before theyleave the hospital,they do deposits.Then once theneeded documentswere submitted,they can refundthe deposit.- HospitalsAdministrativeOfficer also helpcharity patientsonce thePHilhealth Benefitswere maximized.

On my morningrounds, I alwaysmake sure that Italked to phic andnon-phicmembers. Iadvised non-phicto enroll as newmember to availhospital benefitsand explained therequirementsneeded forenrollment andupdating accordingto the new Circular22 s. 2013 andCircular 0028 s.2013. I alsoinstructedmembers onshifting theirmembershipcategory to have acontinuous/updatedcontribution that isneeded duringconfinement. I alsoencountered somegovernmentemployeeswherein theirs nocontribution postedinto their PIN butwith deductions onthere payslip andeven their categorywere not shifted toemployed. Iadvised them tosubmit PMRF, CF1and ER2 fromemployer toupdate hismembership andfor him to availbenefits.

I discussed andinstructedmembers incontinuingpayments byfollowing theguidelinesaccording to officeorders 0112 s.2013 and officememo 257 s.2013. Somepatients andmembers agreedbut some alsowere hesitant topay because itsexpensive. Iexplained to themclearly the benefitsthey can avail andthe possible refundfor the out ofpocket expensesfor medicines andlaboratory exams. none

The hospitalsadministrativeofficer, doctors,clerks and otherhospital staff wereaccommodating.We helped eachother in providingquality health carefor each and everymembers andpatients in thehospital. Hospitalstaffs wereapproachableleading to asmooth transactionand explanation ofnew policies andupdates were alsoadapted.

Benefits of patientswere maximizedand out of pocketreceipts onexpenses formedicines andlabs were collectedby the hospital forfuture refund. Iexplained to themto always writetheir presentaddress on theclaim form forthem to receive thebenefit paymentnotice or follow upafter 2 to 4 monthsat the hospital ornearest PHICoffice. I alsodistributed flyersand pamphletsabout case ratesand benefits forthem to beempowered andknowledgeableabout their rightsfor completebenefit.

This hospital isnon compliant withthe no balancebilling because ofout of pocketexpenses on mostof the drugs andmedicines,laboratories anddiagnostic examsfrom other hospitaland also for privatedoctors excessfee. Statement ofaccount is notautomatically givenon each patientsdischarged and theactual total doctorsfee were notreflected on theSOA. I advisedthem that the soamust be given andthe fees should bereflected but theyonly answered thatif the member onlyrequested for it,they canphotocopy theSOA. andregarding the PF,they just log it ontheir PF receivedlog book.

not yetimplemented

not yetimplemented

Please increaseour transportationallowance becausemost of thehospitals where Iwas assigned wereso far and thetransportation feeis expensive. PROlines were difficultto contact. 2CARES should beassigned in privatehospitals with highbedcapacity/census. New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

11/30/2013 14:38:23 JOANNE JAVIER 4b [email protected]

GOLDEN GATEGENERALHOSPITAL Private 2 11/16 TO 30/2013 89 107 14 8 11 15 244 96 606 601

Hospital clerkswereaccommodatingand approachable.They providedneededinformation aboutpatient/ memberslike daily censusand diagnosisneeded formorning rounds.They also providedlaptops for easyaccess on i-caresand for releasingPCF1. They gavestatement ofaccount for alldischargedpatients reflectingthe total actual PFof doctors and thetotal PHICdeductions.

I do morningrounds to makesure all patient andmembers will beable to use and/orupdate theirmembership. Mostnon-phic wereencouraged toenroll and theywere able to availthe benefitaccording to theirfinal diagnosis. Ialso helpedmembers toupdate theircategory bydistributing thenew PMRF andexplaining the newpolicy regardingupdating andaddingdependents. Alsothose retiredGovernmentemployees whodidn't know thatthey were alreadya lifetime memberswere informedaccording to the i-cares and alsoavailed.

I discussed andinstructedmembers incontinuingpayments byfollowing theguidelinesaccording to officeorders 0112 s.2013 and officememo 257 s.2013. Alsoinformed memberswhere they couldpay premiumcontributions. none

The hospitalsadministrativeofficers, doctors,clerks and otherhospital staff wereaccommodating.We helped eachother in providingquality health carefor each and everymembers andpatients in thehospital. Theywere open onadapting newpolicies andupdates on phic.Some of theconcerns thatneeded immediateactions wererelayed to me andI then reported it tothe PRO or to anyconcerned officesfor immediateaction.

Benefits of patientswere maximizedaccording to theirdiagnosis. Idistributed flyersand pamphlets tohelp members andpatients to beaware of theirbenefits. Ct scanswere paid in casheven if patientswere admitted inthe hospital. Newlyenrolled membersalso enjoyed thebenefits and I alsoadvised them toalways continuethe membership toprevent gap.

NBB notimplemented.

not yetimplemented.

Please increaseour transportationallowance. PROlines were difficultto contact. New Entry

11/30/2013 19:42:58 DAVY LIZARDO 4b


CALATAGANMEDICAREHOSPITAL Government

PCF (Primary CareFacility) 11/04 to 16/ 2013 16 18 0 7 1 11 50 11 53 30

ward roundstogether with thesocial workeridentified patientwho have nophilhealth andencouraging themto enroll tophilhealth,explaining thebenefits andprocedure forenrollment.

1.Erroneousmember datarecord specially4ps member andLGU Sponsored.2.MDR showingvarying degrees ofdiscrepancies.3.Shifting ofmembership fromone category toanother. Usuallyemployedmembers don’tknow how to shift.4.Member is out oftown/country andwho will be theauthorized personto signed the CF1.

1.Members underthe employedsector,government andprivate alike, withremittances thatare not updated.not remitted ontime and havemissed quarters ofremittance.2.Members haveto travel a longdistance just topay their premiumcontributions.Sometimes thecost of travel fortransportation ismore than theirpremiumcontribution that iswhy members(IPP) do not paytheir contributionsdue to distance inwhich will they paytheir premium,requesting andhoping thatphilhealth shouldhave remittancecenter in that area.

Sponsoredmembers/4Ps areunable to availNBB due to thefollowing reasons:(1) 4Psbeneficiaries arenot aware that theyare entitled toPhilHealth benefits(2) Out of pocketexpenses formedicines arebeing incurredwhen admittingdiagnosis differsfrom the case ratefinal diagnosis.

informed thehospital especiallythe social workerwho will assessthe patienteconomicbackground, thatonce the patient isnot member ofphilhealth, memberbut lack ofqualifyingcontribution, theycan still availphilhealth benefitsif they pay thewhole year(current year) fornon members andmissedmonths/quartersfor the members. New Entry

11/30/2013 20:08:56 DAVY LIZARDO 4b


MARYMEDIATRIXMEDICALCENTER Private 3 11/18 TO 30/ 2013 24 7 3 3 1 28 35 119 1105 1105

Assists membersespeciallyindigent/sponsoredwith theirdocumentaryrequirements.Monitored andgatheredprospectivemembers andvalidated if theyare alreadymembers.

Retired membersassumed that theirmembershipcategory will beupdated formIPP/Employed tolifetime member.Erroneousmember datarecord specially4ps member andLGU Sponsored.Informing memberto get mdr or pcf1on CARES even ifthe member hadpresented theirphilhealth ID's.

Payment made atAccreditedCollecting Agentscannot be verifiedthrough iCARES ordelayed posting ofcontributions.Proof of paymentfrom ACAs easilyfades off.Members underthe employedsector,government andprivate alike, withremittances thatare not updated.not remitted ontime and havemissed quarters ofremittance. New Entry

11/30/2013 21:34:06 JHELYN GARBIN 4b [email protected]

SAN JOSEDISTRICTHOSPITAL Government 2 11/1/2013 11/30/2013 75 53 5 35 46 65 80 292 247 247

They alsoencourage patientsto register toPhilhealth and theymonitor theirpatients throughthe BantayPasyente program.

Patients are notaware of Cir no. 22series of 2013which states that"PMRF as the solerequirement forregistration. Mostof them says theydid not enrollbecause of therequirement theyneeded to submit. One client did notavail the benefitsbecause whenthey go to LHIO toregister, one of thestaff says that theyneed to pay 450pesos first then the1800 for the wholeyear. So the clientgot confused anddid not register atall. Most of the formaleconomy membersdid not updatetheir membershipto informal sectorand did notcontinue to paytheir contributions.

Failure of themembers to paytheir contributionsbut because of thenew IRR, theywere able to paytheir missedcontributions andavailed thebenefits.

Private doctorscharged patientswith highprofessional fees.Mostly OB gynedoctors becausethe hospital don'thave resident OBdoctor.

Most of thepatients availed ofthe benefitsbecause of thenew IRR. Some of the clientsgot confusedbecause theirbenefits are notfully explained tothem. They expectthat Philhealth willcover all theirhospital billsincluding theprofessional fees.

Most of themedicines arebought outside thehospital. Some laboratoryexaminations aredone outside of thehospital. Some of heSponsoredmembers withpregnant patientshave no choice butto have private OBdoctors and theyneeded to pay inexcess for theprofessional fees.

All case Rates isnot yetimplemented butthe hospital'sMedical director isasking when it willbe implemented sothat they can havea meeting with alltheir consultantdoctors.

12/1/2013 2:21:27 MILAFLOR ALCURAN [email protected] Roving

ROMBLONDISTRICTHOSPITAL Government 1 11/4 to 9/2013 7 4 2 13 3 15 15

> There are stillconsideredindigents peoplewho do not havetheir ownphilhealth. > Members underformal sector arenot informedregarding changein membershipcategory uponseparation fromtheir respectiveagencies/companies..>Sponsored andindigents membersand theirdependents withdiscrepancy intheir name inMDR. >SeveralPhilHealthmembersespecially underformal economyparticularly theprivate sectors donot know theirPhilhealth number. >Non PhiHealthmembers who arecapable and willingto enroll as IPMbut do not havethe knowledge onthe process andrequirements forenrollment. >GSIS and SSSretirees aremisinformed aboutlifetimemembership, theythought that upontheir retirementthey areautomaticallylifetime membersin PhilHealth. >Indigents andsponsoredmembers whohave multiplePhilHealthIdentificationNumber.

>Members/dependentswith lapsed in theircontributionthought they couldno longer use theirPhilhealth. >Members do notknow where to paytheir contributionsaside fromPhilhealth offices. > Members wholost their officialreceipt onPhilhealthcontribution.

> Some of thePhilhealthmembers/dependentsare not aware ontheir benefitsincluding free ofcharge inmedicines andother hospitalcharges. Theyusually boughttheir medicinesoutside thehospital. > Indigents andsponsoredmembers/dependentsare not wellcompensated intheir benefits claimin governmenthospital due tolack of medicinesand other medicalsupplies.

NBB is notimplemented in thehospital. Philhealthmembers/dependentsstill purchasedmedicines out fromtheir own pocketparticularly theindigents andsponsored onesbecause of lack ofmedicines andother medicalsupplies from thehospital pharmacy.

Not yetimplemented but ifever this will beimplemented verysoon, the hospitalwill be morebenefited becausePhilhealthmembers/dependentshave to buymedicines andother medicalsupplies in thehospital due toshortage of thesein the hospital.Other concern isthat unavailabilityof revolving fund ofthe hospital for themedicinespurchased outsidethe hospital sincethe concernedhospital is underthe provincialgovernment, all thefinancial aspectsshould beconsulted first inthe provincialgovernement.

> Since thehospital in underthe provincialgovernment, all thedecisions/approvallies in theprovincialgovernment. Theystill have to wait forthe memorandumfrom their heads ofoffices in theprovincialgovernment aboutenrolling ofidentified indigentspersons who donot have their ownPhilhealth in theimplementation of"point of care".

> Hazard paysince we are atrisk in acquiringcommunicablediseases and otherdiseases related toour work. > Change inschedule from ourplanned scheduleis very feasible forsudden changesbecause of somereasons:geographicallocation, change inweather conditionwhich is veryunpredictable,unavailability oftransportation fromone isletmunicipality toanother isletmunicipality whichit takes 4-6 hoursof travel via seafrom our place ofresidence.


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/1/2013 2:41:43 MILAFLOR ALCURAN [email protected] Roving

SIBUYANDISTRICTHOSPITAL Government 1

11/1 to 2/2013 &11/11 to 30/13 16 9 3 28 5 20 49 66 61 42

>Sponsored andindigents membersand theirdependents withdiscrepancy intheir name inMDR. >SeveralPhilHealthmembersespecially underformal economyparticularly theprivate sectors donot know theirPhilhealth number. There are stillconsideredindigents peoplewho do not havetheir ownphilhealth. > Members underformal sector arenot informedregarding changein membershipcategory uponseparation fromtheir respectiveagencies/companies.

> Philhealthmembers/dependentsdo not know whereto pay PhilHealthcontributions asidefrom Philhealthoffice > Philhealthmembers withlapsed/gap in theircontributions > Lost/missedofficial receipt ofPhilhealthcontribution.

No available ACAsin the island ofSibuyan, Romblon

> Lack ofmedicines andother medicalsupplies from thehospital pharmacy

> Some of thePhilhealthmembers/dependentsare not aware ontheir benefitsincluding free ofcharge inmedicines andother hospitalcharges. Theyusually boughttheir medicinesoutside thehospital. > Indigents andsponsoredmembers/dependentsare not wellcompensated intheir benefits claimin governmenthospital due tolack of medicinesand other medicalsupplies.

Is not wellimplemented in thehospital becauseof lack ofmedicines andother medicalsupplies in thehospital.Therefore,indigents/sponsoredmembers/dependentsstill bought andpurchasedmedicines andothers medicalsupplies outsidethe hospital.

Not yetimplemented but ifever this will beimplemented verysoon, the hospitalwill be morebenefited becausePhilhealthmembers/dependentshave to buymedicines andother medicalsupplies in thehospital due toshortage of thesein the hospital.Other concern isthat unavailabilityof revolving fund ofthe hospital for themedicinespurchased outsidethe hospital sincethe concernedhospital is underthe provincialgovernment, all thefinancial aspectsshould beconsulted first inthe provincialgovernement.

Since the hospitalin under theprovincialgovernment, all thedecisions/approvallies in theprovincialgovernment. Theystill have to wait forthe memorandumfrom their heads ofoffices in theprovincialgovernment aboutenrolling ofidentified indigentspersons who donot have their ownPhilhealth in theimplementation of"point of care"

> Hazard paysince we are atrisk in acquiringcommunicablediseases and otherdiseases related toour work. > Change inschedule from ourplanned scheduleis very feasible forsudden changesbecause of somereasons:geographicallocation, change inweather conditionwhich is veryunpredictable,unavailability oftransportation fromone isletmunicipality toanother isletmunicipality whichit takes 4-6 hoursof travel via seafrom our place ofresidence New Entry

12/1/2013 7:28:51 MARY GRACE RONDAEL 4b [email protected]

BULALACAOCOMMUNITYHOSPITAL Government 1

11/4 to9 2013;11/18 to 23 2013 3 2 0 20 9 10 29

Some ofBulalacaononavailed themembership in PhilHealth by paying a1,800 as annualcontribution. Theymuch felt thankyou to the HealthInsurance bygetting to thisnewest policy,must of them saysthat the Phil HealthInsurance givethem moreimportance.

Some of ouremployed PhilHealth memberhave a difficulty ingetting of theirsigned CF1 to theiremployment forthe reason of: theemployer in basedon our town,delayed issuanceof signed CF1 fromthe employer.

Requesting to thehigher authority toplease allowedPalawan PeraPadala ascollecting agent forPhil Healthcontribution for thereason ofunavailability ofLBC and BayadCenter on the saidarea

Some of our PhilHealth membercomplaint thatsome of staffnurses in that saidhospital makesome undesiredsounds that makesinterferes theresting time of ourconfined PhilHealth members.

The said hospitaland thebulalacanon feltmuch importancein the newestpolicy by allowingthem to be a PhilHealth memberand availed thebenefits by paying1,800 as annualcontribution.

Actively involved toprovide the nobalance billing toour Phil Healthmember /dependents.

Much aware to thecases of our PhiHealth members /dependents toprovide their needsto gain the highestcare.

Not yetimplemented in thesaid hospital.

Requesting to thehigher authority toplease provides usthe a list or copy ofload allowance asreference. New Entry

12/1/2013 8:37:48 MARY GRACE RONDAEL 4b [email protected]

BULALACAOCOMMUNITYHOSPITAL Government 1

11/4 to9 2013;11/18 to 23 2013 3 2 0 20 9 10 29

SomeBulalacaonon feltmore importanceto our newestpolicy by paying1800 for annualcontribution. Theymust felt thank youto the healthinsurance byallowing them tobe a member ofPhil health.

Delayed issuanceby the employer ofCF1 to ourprivately employedmember.

Requesting to thehigher authority toallowed thePalawan PeraPadala to be asone of collectingagaent of premiumcontribution for thereason ofunavailability ofLBC o BayadCenter on the saidarea.

Some of our Philhealth membercomplaint thatsome of nurses ofthe said hospitalmake a unwantedsounds thatinterferes theirsleeping time.

The hospital staffand bulalacaononare felt muchimportance in thenewest policygoverning by theHealth Insurance.

The said hospitalmake their activelyinvolving inproviding our PhilHealth member aNo balance billing.

The said hospitalmake their best togive the highestcare for all thepatients in all caserate.

Not yetimplemented in thesaid hospital.

We are requestingto the higherauthority to pleaseprovide us a copyof list of loadallowance thatthey given to us. Corrected Entry

12/1/2013 8:43:18 EVA MADLANGBAYAN 4b


BAUAN GENERALHOSPITAL Government 2 11/1/2013 11/30/2013 12 12 0 4 5 3 8 342 170 172

1.Member whowants todeactivate heraccount and wantsto become adependent of herhusband come toPhilHealth CARESpost to asked therequirements indoing so. 2. A previouslyemployed memberwants to shift toindividually payingmember butdoesn't know howto do so and therequirementsneeded. 3. An individuallypaying memberasked the CARESon duty if she candeclare her motherwho is currentlyadmitted at thesaid hospital. hermother will turn 60next year.

1. Non- Memberasked if he will beenrolled asmember, howmuch he will pay ifhe's going to payfor one whole year. 2. An ofw memberasked if thebenefits themember can availis depend on theamount ofcontribution themember pay.

1. Clerk file theirhospital claimsbeyond 60 days. 2. Clerk doesn'taware on 3 monthswithin 6 months(3/6) requirementin order to availbenefits for thosemember whosedependent ormember itself wasadmitted whethermedical or surgicalcases. Clerk arenot updated/awareon the new IRR. 3. The previouslymember whosemissed to paid theApril-September2013 asked me ifshe can still paythe missed quarterand she can stillable to avail thePHIC benefitsbecause herdaughter wasadmitted due toPneumonia.

1. The hospital arestill not compliantwith the NoBalance BillingPolicy. Themedicines (i meanALL themedicines) aresold by the patientoutside thehospital premises.Even IV Fluids arenot available thepharmacy.. TheSponsored/4P'sare alwayscomplaining 'cozthey have a lot ofout of the pocketfor that admission. New Entry

12/1/2013 9:29:46 MARY GRACE RONDAEL 4b [email protected] MindoroProvincial Hospital Government 2

11/11 to 16 2013;11/25 to 30 2013 9 18 2 48 21 12 69 678 970 898

The hospitalpharmacy headget to know theconcerns of ourmember in termsof purchasingmedicines and wellinformed their staffin the situation ofour member astheir client.

Some of ourmember still holderof a double Philhealth cards withthe same validity.

The IPM undernew categoryInformal as muchwell appreciatedand enjoying thenew governingpolicies of theHealth Insurance.They give gratitudeto the Higherauthority by saying" mas magandangayon ang policyng Phil Health masmatutulongan angmga member,salamat atmamagamit kaming Phil Health,Malaking tulong saamin. Thank youpo." as verbalizedby one of my clientsignificant othersduring ward visit.

To LBC pleaseprovide readableprint out of asproof of paymentfor our members.

Knowing theconcerns of ourmember by gettingin touch to ourmembers andsignificant othersand take theappropriate action.

On the part ofhospital: failure ofsubmission of theclaims to the PhilHealth RegionalOffice before onthe end of thegiven time on theother hand ourmember badderwhen theyreceived a letterfrom our PRO.

The hospital ofOriental Mindorogive their best toprovide the NOBalance Billing toour member bycoordination toother pharmacywith in vicinity toprovide theprescribemedicines in casethe said medicinesis unavailableinside the hospitalpharmacy.

Well implementedin the saidhospital.

Not yetimplemented in thehospital ofProvince ofOriental Miondoro.

Please provide usa copy ofcomputation of ourtaxes. New Entry

12/1/2013 10:38:59 DANICCA VINO 4b [email protected]

LIPA CITYDISTRICTHOSPITAL Government 1 11/4/2013 11/29/2013 30 37 0 3 29 3 30 389 587 587

There are someinstances that themembers ordependents cannotsubmit therequirementsneeded by thehospital philhealthclerk give a oneweek period to beable to accomplishit. It is more oftenhappen for thoseemployedmembers whereintheir employercannot sign theCf1.

For almost onemonth of duty,there are minimalissues regardingmembership likefor the sponsoredprogram somemembers do notknow how longtheir validityperiod. There aresome nonphilhealthmembers do notknow how to apply.

There are manyphilhealthmembers still donot know the newpolicy of philhealthregarding thecontributions andas a responsibleCARES nurses weexplained to themthat even if theymissed quatercontribution theycan still pay theprevious quarter.

During our dutythere are no issuesreported to us

there are noresident doctorslike OB, surgeonthats why patientsdo not have anychoice but to call aprivate doctors.

There are manyphilhealthmembers do notknow thebreakdown of thebenefits ofphilhealth. thereare alwayspointing out thatthey cannot feelthe benefitsprovided by thecorporation when itcomes to theprofessional feesof the doctorsbandas we observedpatients are rightbecauseprofessional feesof doctors are likethey are admittedin a privatehospital.Some memberssays'' sa halip namapamura kme atpag aari ito nggobyerno lalonman kme napapamahal"

Still the hospital donot implementedthe Nbb themembers stillpayed for themedications andother laboratoryexam.

All case rate stillnot implemented

during our dutythere are no issuesabout it.

There are nocomputer providedby the CARESnurses. As far asCARES whereconcerned doing ofrounds is still ahealth threat for usbecause we don'tknow all theconditions ofpatients. New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/1/2013 11:49:22 PRINCESS JOY MACMAC 4b [email protected]

Culion Sanitarium& General Hospital Government 2 11/1/2013 11/29/2013 9 10 0 54 1 10 14 110 127 125 *none

● Dependentdeclared in MDRare not LEGALdependent (NotLegally Married,GrandchildrenDeclared) ● Sponsoredmembers whoshowed manydiscrepancies intheir MDR. ● Sponsoredbeneficiaries whowere not legalbearer of theirsurname who werelisted in philhealthfound hard time touse their benefits,or they cannot usetheir philhealthwithout any legaldocumentpresented esp. 4p’s spousebeneficiaries. ● Members havemore than 2 pins,especially thosewho are underNHTS and LGUsponsored.

● Members underthe employedsector,government andprivate alike, withremittances thatare not updated.not remitted ontime and havemissed quarters ofremittance. ● IPP lost theirreceipt of premiumcontributions.

● The receipt thathas been releasedby the accreditedcollecting agentparticularly LBC-coron easily fadesoff.

● Members are notaware where to gettheirreimbursements. ● DifficultyunderstandingBPNs, especiallyfor those illiteratemembers. ● Clarificationregarding SPC 90-day ruling if it isrenewed everycalendar year.

● The hospital isstrictlyimplementing theNBB policy for allthe indigentmembers.

● The hospital isstrictlyimplementing ACRpolicy for all theentitled membersof philhealth

● The CARESproject is verywelcome in thisinstitution. Theyhave greatexpectations forthe cares assignedhere. And all theemployees arevery kind andaccommodatingand also the chiefof hospital. New Entry

12/1/2013 12:27:16 BERNADETTE BACOSA 4b

[email protected]

SOUTHERNPALAWANPROVINCIALHOSPITAL Government 1 11/1/2013 11/30/2013 14 17 2 64 32 10 139 215 127 127

-Errors inmember/dependentdata record-Unavailability ofdocumentsrequired for dataamendment.

-Inaccessibility onpayment methodwithin localitygiven that LBC,LBP and PostalOffice are not yetallowed to acceptpayment ininstances whereinmember lack atleast three (3)months within thesix (6) monthscontribution priorto the first day ofavailment requiringthem to pay in fullthe whole calendaryear or remainingunpaid months forthe year.

-In order to complywith the provisionsof No BalanceBilling Policy, theSouthern PalawanProvincial Hospital,made anagreement with acertain privatepharmacy in thearea to ensure theavailability of drugsand medicinesneeded by thePhilHealthsponsoredmember admittedfor the conditionscovered undercase rates. Thereare instanceshowever that thedrugs andmedicinesobtained bysponsoredmembers in thatpharmacy exceedon the totalamount of packagecovered byPhilHealth, thusrequiring them topay the excess. New Entry

12/1/2013 12:53:48

ISAGANILEONCIO TAN 4b [email protected]

Saint PatrickHospital Private 2 11/1 to 11/15 0 0 0 0 0 0 -1 0 0 0

The hospital wereable to adapt thecirculars issued bythe Institution asper PCARESassistance

Informed theadmittingdepartment aboutthe IRR 10606 Good

Philhealthmembers wereable to availedtheir benefits assoon as theirPhilhealthrequirements aresubmitted. New Entry

12/1/2013 13:09:53

ISAGANILEONCIO TAN 4b [email protected]

Medical CenterWestern Balayan Private 2 11/16 to 11/30 29 40 11 0 4 14 0 67 281 288

The hospitaladmitting sectionwere able toinformed clientsthat they havePcares to assistPhilhealthmembers if theirphilhealthrequirements arenot completed.

Informed theclients the newIRR 10606 if theirpatients are not yetmember.

Informed the 3/6policy of Philhealthand the 1 yearcontribution if theyare not yetenrolled in thePHIC. Good

Informed the Caserate to themembers New Entry

12/1/2013 13:44:48 MARTA RAFAELA DEMETRIO 4b [email protected]

MALIPAYONDISTRICTHOSPITAL Government

PCF (Primary CareFacility) NOVEMBER 4-9 1 0 0 2 0 2 2 227 89 89

Automaticavailment ofnewborn screeningprior to dischargeof patient.

Still erroneousMDR's speciallywith our indigentand sponsporedmembers.

Members that hadmissedcontributions werenot aware that bynext yearcontribution willincrease to twohundred per monthand complains thatthis is somehownot affordableespecially withsome of theinformal sectormembers andsponsoredmembers whosevalidity hadalready expired

Since the locationof the hospital isgeographically notaccessible to andfrom our LHIO andalso no availableACA in saidmunicipality,collections aresomehowimpossible.

Hospita clerkseldomly attendupdates andunaware of newcirculars.

Not all benefits areavailed since thisis only a primarycare facilty.

NBB not fullyimplemented dueto lack ofmedicines anddrugs( no hospitalpharmacy ),andother supplies. N/ A Not implemented.

No access toicares,nocomputer,nointernet connectionand power supplyis only scheduled. New Entry

12/1/2013 13:59:42 MARTA RAFAELA DEMETRIO 4b [email protected]

ROMBLONPROVINCIALHOSPITAL Government 1 11/10 to 30/2013 66 30 4 34 3 18 56 227 89 89

Almost fullimplementation ofNBB andautomaticavailment of Newborn screeningprior to discharge.

Erroneous MDR'smost specially withour sponsored andindigent members.

Common inquiriesregards to theamount ofcontribution andmode of payment. None.

Good workrelationship withthe hcp.

PCB not yetimplemented andpackage for animalbite as well.

Almost fullyimplemented butout of pocketexpenses were stillunavoidable due tounavailablity ofsome medicinesand supplies andlaboratoryexaminations.

Not yetimplemented as ofnow.

Not yetimplemented as ofnow.

Still no computerand internetconnectionprovided.noiCares,no IHCPportal access. New Entry

12/1/2013 14:35:54 NERISA PANGANIBAN 4b

[email protected]/[email protected]

SAN JUANDISTRICTHOSPITAL Government 1 11/3-16/2013 26 27 1 28 17 30 129

>Erroneous profileor MDR.> Sponsoredmembers havedifficulty inproviding proof ofidentity forerroneous profile.

> Positivefeedbacks on thenew IRR policyabout theamendment of the9/12 contributionand theimplementation ofthe 3/6 policy orthe full payment ofcontribution fornon-members/inactivemembers. >Hospital Clerksare still confusedabout the new IRRpolicy in payingcontributions.

>Members have totravel a longdistance just topay their premiumcontributions.

>Professional feescharges increasedwhen the patienthas Philhealth.

>delayed issuanceof BPN. >delayed issuanceofrefund/reimbursement. >Professional feescharges increasedwhen the patienthas Philhealth

•Sponsoredmembers/4p’s areunable to avail trueNBB due to thefollowing reasons:(1)Out of thepocket expensesfor medicines thatare not availableinside the hospital.(2)Out of thepocket payment fordiagnostic test thatare not availableinside the hospital.(3)Insufficient/Unavailabilityof medicines insidethe hospital.(4) Professionalfees for PrivateDoctors who areResidence on dutyfrom the time ofadmission of theclients.

Logistics>Hospital mustprovide computerfor CARE’s usedonly. New Entry

12/1/2013 14:48:59 NERISA PANGANIBAN 4b

[email protected]/[email protected]

LOBO MUNICIPALHOSPITAL Government 1 11/18-29/2013 17 15 0 13 11 17 73 41 111 90

> Sponsoredmembers havedifficulty inproviding proof ofidentity forerroneous profile.>Erroneous profileor MDR.

> Positivefeedbacks on thenew IRR policyabout theamendment of the9/12 contributionand theimplementation ofthe 3/6 policy orthe full payment ofcontribution fornon-members/inactivemembers. >Hospital Clerksare still confusedabout the new IRRpolicy in payingcontributions.

> Members andNon-phic membersare requesting forthe allocation ofnearest bayadcenters or anAccreditedCollecting Agentsnear theMunicpality. Oneof the cause ofunavailment of thebenefits is thelocation andadditionalexpenses for thetransportation.

> "Professional fee+ Philhealth"confused themembers uponpaying theirHospital bill.

>member who isout of the countryhave difficulty inproviding thenecessaryrequirement forbenefit availmentof her dependents. >Members are notaware where to gettheirreimbursements. >delayed issuanceof BPN. >delayed issuanceofrefund/reimbursement. >PF chargesincreased whenthe patient hasPhilhealth

•Sponsoredmembers/4p’s areunable to avail trueNBB due to thefollowing reasons:(1)Out of thepocket expensesfor medicines thatare not availableinside the hospital.(2)Out of thepocket payment fordiagnostic test thatare not availableinside the hospital.(3)Insufficient/Unavailabilityof medicines insidethe hospital.

Logistics>Hospital mustprovide computerfor CARE’s usedonly. New Entry

12/1/2013 16:44:55 SHAWLYN LAYA 4b


BAUANDOCTORSGENERALHOSPITAL Private 2 11/01 TO 15 /2013 61 72 8 13 0 22 34

UPONADMITTINGPATIENTS,HOSPITALEXPLAINED THENEEDEDREQUIREMENTSTO AVAILPHILHEALTHBENNEFITS ANDFOR PATIENTSWITH NOPHILHEALTHTHEY REFERTHEM TOPHILHEALTHCARES.

MOST OFINDIGENTMEMBERS WEREABLE TOCONTINUEAVAILINGBENEFITS FROMPHILHEALTH BYSHIFTING TOINFORMALCATEGORY ANDPAY THE WHOLEYEAR OF 2013.

MEMBERS FROMINFORMALSECTOR WASINFORMEDABOUT THE NEWPOLICY OFPHILHEALTHREGARDINGTHEIR PREMIUMCONTRIBUTION. New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/1/2013 17:12:19 JAN BERRAY ALDABA 4b [email protected]

PINAMALAYANCOMMUNITYHOSPITAL Government 1 11/04-07/2013 10 16 2 22 20 16 56

●Erroneousmember datarecord specially4ps member andLGU Sponsored.MDR showingvarying degrees ofdiscrepancies.●Shifting ofmembership fromone category toanother. Usuallyemployedmembers don’tknow how to shift.●4P's memberwithout ID toprovide, they onlyhave theagreement/certificationthat they are partof the program.Unfortunately,what we honor isjust the idetificationcard.

●IPP lost theirreceipt of premiumcontributions.●Members have totravel a longdistance just topay their premiumcontributions.Sometimes thecost of travel fortransportation ismore than theirpremiumcontribution.●Most of myclients was still notaware of theincrease ofpremiumcontribution bynext year.

●Members are notaware where to gettheirreimbursements.●The benefits ofthe member arenot maximized oncase rates.●Most of myclients were notaware of the new3/6 policy for allcases.

● Out of pocketexpenses formedicines/suppliesof philhealth clientsdue tounavailability in thehospital.● Laboratory wasnot availableduring my stay inthe hospital due tounavailability ofelectric power insome parts of thehospital buildingsincluding thelaboratory section.● Water to drinkwas not providedfor the patients. Nocurtains toseparate patientsin the ward andpoor ventilationwas observed.

● The benefits ofthe member arenot maximized oncase rates.

● The hospital justprovide a smalltable and a chairbeside theinformation desk.We don't evenhave the fan forventilation andanother chair forourclients/customer.Our client is juststanding in front ofour desk while weare explaining fortheir inqueries. New Entry

12/1/2013 17:17:52 SHAWLYN LAYA 4b


LIPA MEDIXMEDICALCENTER Private 2 11/16 TO 30 /2013 72 63 21 11 0 43 56 71 961 961

THEYIMMEDIATELYPROVIDE PMRFFOR PATIENTSWITH NOPHILHEALTH TOBE USED ANDREFER TOPHILHEALTHCARES FORQUERIESREGARDINGNEW POLICIES.

DEPENDENT-DAUGHTER WHOGAVE BIRTHWEREENCOURAGEENROLL INORDER TO AVAILPHILHEALTHBENEFITS.

MEMBERSFROMBINFORMALSECTOR WEREABLE TO AVAILPHILHEALTHBENEFITS BYPAYING THEIRMISSEDQUARTER/S.

SOMEEMPLOYERSFROM FORMAL-PRIVATESECTORPROVIDE CF1REVISION OF2009 WHICHCAUSES RTH OFTHE HOSPITAL. New Entry

12/1/2013 17:50:47 JONAH ROSARIO AUSTRIA 4b


CORONDISTRICTHOSPITAL Government 1 11/1/2013 11/30/2013 8 11 3 28 10 7 68 129 90 58

•Somemembers/dependentswere unable tocomply theirrequirementsneeded assupportingdocuments to availphilhealth benefits •The legaldocuments ofsome membersneed to have anaffidavit from alawyer because ofdiscrepancies fromthe data given,such as incorrectname spelling,different middlenames and etc.

•Insufficient/Unavailabilityof some prescribesmedicines andmedical supplies.

Sponsoredmembers weremade to buyprescribedmedicines outsidethe hospitalpharmacy as wellsome medicalsupplies neededfor laboratory. New Entry

12/1/2013 17:51:31 RELAN MAPA 4b [email protected]

NORTHERNPALAWANPROVINCIALHOSPITAL Government 1 11/1/2013 11/30/2013 14 6 3 65 13 30 37 137 127 120

Erroneous recordcommonlyencountered tothose under theNHTS andsponsoredprogram.

Referring to ourmembers underthe formaleconomy, postingof contribution ondata basecommonlyobserved notupdated. Thus,forcing themember to submitadditionalrequirements(Certificate ofContribution) inaddition to theminimumrequirement beingrequired.

1. Under utilizationof NHIP benefits.Case rate cannotmaximize due tolimited hospitalsupplies, drugsand medicines aswell as reagentbeing used inlaboratory.2.Misrepresentationby FurnishingFalse or IncorrectInformation.Changing of finaldiagnosis from notcompensabledisease intocompensable onefor claimingpurposes.

Non - complianceto NBB policy. ALLqualifiedmember/dependentspent out of pocketfor drugs andmedicines.Laboratory alsobeing charged toqualified NHIPpatient. New Entry


ROXAS DISTRICTHOSPITAL Government 1 11/18 to 23/2013 17 7 1 28 23 17 71

● A sponsoredmember whoneeds thecertification issuedby the Office dueto unavailability ofthe validity in thesystem. Accordingto the PhilhealthStaff, maybe themember is subjectfor termination andneeds thatcertification oncethemember/dependentsconfined in thehospital.● Erroneousmember datarecord specially4ps member andLGU Sponsored.MDR showingvarying degrees ofdiscrepancies.●Shifting ofmembership fromone category toanother. Usuallyemployedmembers don’tknow how to shift.●4P's memberwithout ID toprovide, they onlyhave theagreement/certificationthat they are partof the program.Unfortunately,what we honor isjust the idetificationcard.

● The PhilhealthStaff assigned intheir municipalitywere just presentevery other Friday.Too seldom,according to myclients that Iinterviewed.● IPP lost theirreceipt of premiumcontributions.●Members have totravel a longdistance just topay their premiumcontributions.Sometimes thecost of travel fortransportation ismore than theirpremiumcontribution.●Most of myclients was still notaware of theincrease ofpremiumcontribution bynext year.

● The philhealthclerk of thehospital wereconfusedregarding theCircular 20 s.2008. What theyknew was the 5thpregnancy withabortion was notcovered byphilhealth benefits.● Members arenot aware where toget theirreimbursements.●The benefits ofthe member arenot maximized oncase rates.●Most of myclients were notaware of the new3/6 policy for allcases.

● Out of pocketexpenses formedicines/suppliesof philhealth clientsdue tounavailability in thehospital.● Laboratorywas not availableduring my stay inthe hospital due tounavailability ofelectric power insome parts of thehospital buildingsincluding thelaboratory section.● Water to drinkwas not providedfor the patients. Nocurtains toseparate patientsin the ward andpoor ventilationwas observed.

● The benefits ofthe member arenot maximized oncase rates.

● We can't usethe portal once weneed duringSaturday becausethe staff who usesthe computer wereonly present duringweekdays. New Entry

12/1/2013 18:47:13

RACHELLEMOREEN BATHAN 4b


LEMERYDOCTORSMEDICALCENTER Private 2 11/4 TO 11/9/2013 7 6 0 1 2 2 2

-THE CLERK OFTHE HOSPITALSTILL ASKEDFOR UPDATEDMDR EVEN THEMEMBER(PATIENT) HADPHILHEALTH ID.-SOME MDRSPECIALLY THESPONSORED/INDIGENTMEMBER HASDISCREPANCIESIN THEIR NAMESAND OTHERDATAS.

-THE HOSPITALADMINISTRATOR,CLERKS ANDSTAFF AREGOOD TO US.

-REQUEST FORHAZARD PAYAND FLU,MENINGGOCOCCEMIA,PNEUMONIAVACCINE,PROTECTIVEEQUIPMENT LIKEMASK.-THE POST OFCARES IN THEHOSPITAL WASAT THEINFORMATIONAREA, WHEREINTHE CLIENTSTHOUGHT USINFORMATIONCLERK, AND THEAREA WAS NEARTHE OUTPATIENT AREAOF THE CLINICALDOCTORS WEREMOST OF THEPATIENTS HASPULMO CASESLIKE TB.PNEUMONIACASES, AND NOCLIENT ASKEDFORASSISTANCEBECAUSE MOSTOF THE CLIENTSDIRECTLY WENTTO THEPHILHEALTHOFFICE THAT'SWHY MAKE APOINT TO DOROUNDS. New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/1/2013 19:01:16 ALLEN AUBREY ARAJA 4b


MAHAL NAVIRGEN MARIASTO. ROSARIODISTRICTHOPITAL Government 1 11/1/2013 11/30/2013 17 8 3 22 34 26 67 102 304 304

THE CHIEF OFHOSPITAL WASVERYACCOMMODATINGAS WELL AS THESTAFFS. THEYWELCOME THECOMMENTS ANDSUGGESTIONSMADE FOR THEIMPROVEMENTOF THEPHILHEALTHACCREDITEDFACILITY.ALTHOUGH,SOME OF THECLAIM FORMSWERE NOTACCEPTEDSPECIALLY OFTHOSE OF THESPONSOREDMEMBERS,CARES NURSEIMMEDIATELYTALKED TO THEPHILHEALTHCLERK FORCLARIFICATIONSANDCORRECTIONS.

NOT ALL THE IN-PATIENTS AREMEMBERS.SIMPLIFIEDMEANS OFBEING AMEMBERSPECIFICALLYTHE REVISEDPMRF AND NONEED FOR THESUPPORTINGDOCUMENTS ISA MUCH BETTRWAY OF BEING AMEMBER.

3/6 OR PAYINGTHE WHOLEYEAR GIVESEFFECTIVENESSAND TO OBTAINTHE UNIVERSALHEALTHCARE. NONE

THEHEALTHCAREPROVIDER(HOSPITAL &DOCTORS) AREVERYACCOMMODATINGAND OPEN TOISSUES ANDCONCERNSBEING BROUGHTUP. THEY AREWILLING TONEGOTIATE ANDIMPROVE THEQUALITY OFHEALTH SO ASTO GIVE ABETTER ACCESSTO HEALTHCARE.

NOT ON TIMERELEASE OFBENEFITPAYMENTNOTICE AND THERELEASE OFREIMBURSEMENTSTO MEMBERSDUE TO THEREMITTANCESOF THEHOSPITALS AREBEING BROUGHTTO THEPROVINCIALGOVERNMENTAND AFTER AWEEK OR SOTHERE WILL BETHE RELEASINGOF THEREIMBURSEMENTS.

THE NOBALANCEBILLING IS NOTYETIMPLEMENTED.LACK OFMEDICINES ANDSUPPLIES GIVENTO HOSPITALSBY THEPROVINCIALHEALTH OFFICE.

NOT BEINGIMPLEMENTEDSO FAR.

THE HOSPITALSSEE TO IT THATTHEY WILL GIVETHE MAXIMUMPOINT OF CARETO PATIENTS.THERE IS A LACKOF SUPPLIESAND DRUGSTHAT IS AHINDRANCE TOGIVING THEMAXIMUM POINTOF CARE. NONE. New Entry


ORIENTALMINDOROPROVINCIALHOSPITAL Government 1

11/11 to 16 & 25 to30/2013 37 38 2 51 48 17 103 678 970 898

● Erroneousmember datarecord specially4ps member andLGU Sponsored.MDR showingvarying degrees ofdiscrepancies.●Shifting ofmembership fromone category toanother. Usuallyemployedmembers don’tknow how to shift.●4P's memberwithout ID toprovide, they onlyhave theagreement/certificationthat they are partof the program.Unfortunately,what we honor isjust the idetificationcard.

● IPP lost theirreceipt of premiumcontributions.●Most of myclients was still notaware of theincrease ofpremiumcontribution bynext year.

● Members arenot aware where toget theirreimbursements.●The benefits ofthe member arenot maximized oncase rates.●Most of myclients were notaware of the new3/6 policy for allcases and the newpolicy wherein youneed to pay thewhole year for youto avail thebenefits.

● Out of pocketexpenses formedicines/suppliesof philhealth clientsdue tounavailability in thehospital.● Water to drinkwas not providedfor the patients. Nocurtains toseparate patientsin the ward andpoor ventilationwas observed.

● The benefits ofthe member arenot maximized oncase rates. New Entry

12/1/2013 19:09:42 EUNISE GRACE PEDRAJA 4b


DANIEL O.MERCADOMEDICALCENTER Private 2 11/17 to 23 /2013 72 37 10 33 27 45 78 35 94 72

-Misconceptionabout unmarriedparents are notallowed to declaretheir children asdependent -Multiplemembership(sponsoredmember is also anemployedmember/ an activemember is also adependent)

-Doubledcontribution foremployed memberwith two active job -Late remittance ofprivate companies

-Too expensiveprofessional feesof private doctors

-Difficulty availingbenefits when themember is abroadand no nearest kinavailable to signon claim form 1 -Too manyrequirements toavail benefits -Lack ofknowledge aboutnew IRR -Privatecompanies notreleasingcertificate ofPhilhealthcontribution if themember is alreadyresigned

-Personalcomputer withinternet accessshould be providedin every hospitalwhere CARES areassigned for moreeffective deliveryof services New Entry

12/1/2013 19:13:26



METRO LEMERYMEDICALCENTER Private 2 11/11 TO 16/2013 11 20 1 1 3 5 0

-CLIENT WHOWANTS TOENROLL INPHILHEALTH IGAVE HIM PMRFANDINSTRUCTED TOGO TO LHIO, THECLIENT CAMEBACK AND THELHIOPERSONNELASKED FORDOCUMENTARYREQUIREMENTS,EVEN IF PC # 22WAS ALREADYIMPLEMENTED,SO I CALLED THELHIO OFFICEAND ASKED WHYARE THEYASKINGDOCUMENTSWHERE IN THECLIENT TOWANTS TOENROLL ALSOTHE PERSONWHO WENT TOTHEIR OFFICE.-THE CLERKSSTILL ASKEDFOR UPDATEDMDR AND NOTACCEPTEDSUPPORTINGDOCUMENTSFOR THEELIGIBLEDEPENDENTSAND FORCORRECTION OFTHE DETAILS OFMEMEBERS ANDDEPENDENTS.

-THEY AREGOOD

-HAZARD PAYFOR USBECAUSEWHERE AT RISKTO DIFFERENTDISEASESESPECIALLYDURING WARDROUNDS.-PROTECTIVEMASK. New Entry

12/1/2013 19:24:15



OUR LADY OFCAYSASAYMEDICALCENTER Private 2

11/18 TO11/23/2013 8 9 1 1 2 4 4

-MDR SHOWINGDISCREPANCIESIN THEMEMBERS NAMEANDDEPENDENTS.

-CONTRIBUTIONSOF EMPLOYEDMEMBERS ARENOT UPDATED INTHE ICARES,THATS WHYSOME OF THERTH CLAIMS AREDUE TO LATEPOSTING OFCONTRIBUTIONEVEN IF THEEMPLOYERALREADY PAIDFOR THEINTENDEDMONTHS.

-THEY ARE NICEAND GOOD TOUS AND THEYTRUST CARES

-MOST OF THEDIALYSISPHILHEALTHPATIENT HASEXHAUSTEDTHEIR 45 DAYSLIMIT/YEAR,THATS WHYTHEY AREASKING FORADDITIONALALLOWANCEFOR THEIRCASE.

-SINCE WEWHERE ASKEDFOR THE WARDROUNDS WEARE ALSOASKING FORHAZARD PAY,FLU ,PNEUMONIAVACCINES,PROTECTIVEWEARS(MASK)FOR OURPROTECTION. New Entry

12/1/2013 19:39:01 EUNISE GRACE PEDRAJA 4b


ST. CABRINIMEDICALCENTER Private 2 11/25 to 30 /2013 87 28 5 37 43 35 59 89 298 265

-Married childbelow 21 years olda dependent ofboth her husbandand her parents -Lack ofknowledge on howto deactivatemembership inorder to bedeclared asdependent -Live-in partnerdeclared asdependent

-Questionablemonthly Philhealthdeduction foremployedmembers -Some privatecompanies willonly remitPhilhealthcontribution whenthe employee isasking certificateof contribution

- Too expensiveprofessional feesof private doctors

-Unawarenessabout 45 daysbenefitallowanceper yearof member anddependent -Lack ofknowledge aboutdirect filing -QuestionablePhilhealthdeduction whenunder Fee-for-Service -A lot ofrequirements tooavail benefits -Unawarenessabout the new IRR

-Personalcomputer withinternet accessshould be providedat every hospitalwhere CARES areassigned topromote fullfunction of CARES New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/1/2013 19:54:01

JOSEPHHARROLD SULIT 4b [email protected]

BATANGASHEALTH CARE(JESUS OFNAZARETHHOSPITAL) Private 2 11/01 to 11/15 24 16 7 14 38 18 24 31 43 30

Uponadmission/arrivalat the ER, thepatient wouldalready bedetermined ifhe/she is aPhilhealthmember/dependent.Then the admittingclerk would thenrefer the relative orthe patient to usCARES in orderfor us to explainwhat they couldexpect fromPhilhealth and atthe same timeclarify questionsregarding neededrequirements foravailment. The CARES Issituated at theadmitting sectiontogether with theEBD health card(local governmentfinancial aid forindigent peopleBATANGASCITY). This was aneffective locationsince we couldwork together withthe EBD personneland they wouldendorse to us theirpatients withoutPhilhealth so wecould talk to themand tell them thebenefits of beingmembers.

- erroneous dataon the member'sMDR (name,age,date of birth etc)multiple PIN formembers- dependentsdeclared on theirMDRs are notlegal dependents(sponsoredmembers)- inquiries aboutthe process ofshifting from onemembershipcategory toanother- confusion on thePMRF as the solesource ofinformation of anapplicant memberwas resolved andcoordinated withthe PRO

- clearedcontribution issuesto Informal andFormal members- clearedcontributionrequirements fornewly enrolledmembers for themto immediatelyavail their benefits N/A

- Explained thechange inrequirements forPhysician who areapplying orrenewingPhilhealthAccreditation

- discussed thedifference betweenthe FFS schemeand the Case RatePayment schemeto members.- Informedmembers thepossibility ofimmediate benefitavailment if theywould pay for theentire calendaryear

The Hospital triesto comply with theNBB howeversometime somemedications areneeded to bebought outside ofthe hospital.

not yetimplementing ACR

No On site Point ofCare

The hospital areaccommodating tothe CARES projectinformation.However at someinstances thePhilhealth section'sadvise to the clientwould differ theadvise of thePhilhealth CARESon duty in order forthe member toavail his/herbenefits There is acomputer providedexclusively for theCARES on duty. The Philhealthsection prefers theissuance of PCF1even if themember has anMDR on hand ifthere would beadding ofdependents thruattachment ofsupportingdocuments New Entry

12/1/2013 19:55:22

MARIAROSAPHIA GONZALES 4b


LAURELMEMORIALDISTRICTHOSPITAL Government 2 11/4/2013 11/29/2013 154 98 2 12 69 33 368 398 252 209

Some nonPhilhealthMembers werereferred by SocialWorker to CARESfor educating andencourage client tobe a PhilHealthmember.

PhilhealthCoverage for PFwere not deductedbut added toexcessProfessional fee.Admitted patientwithout IVF werenot having theirdaily foodsupplied.

All specialist areprivate doctors, outof pocketprofessional feeare paid by themember.Newbornscreening shouldbe paid first andpayment will bereimburse afterPHIC paid thehospital.Medicines andlaboratory are alsoout of pocket, iteither medicine arenot available in thepharmacy or themember needs tocomplete thePhilhealthrequirement first. New Entry

12/1/2013 20:00:08



TAALPOLYMEDICHOSPITAL ANDMEDICALCENTER Private 2

11/25 TO11/30/2013 13 11 0 5 0 5 0 46 212 234

-THEY MAKE APOINT THAT THECLERKS HADTHEIR ROUNDSTO CHECK THEPHILHEALTHREQUIREMENTSOF THEIRCLIENTS AND TOCHECK THENONEPHILHEALTHMEMBERS ANDTHEYDISTRIBUTEPMRF ORINSTRUCT THEMTO GO TO LHIOOFFICE FORENROLLMENT INPHILHEALTH

-SOME MDRSHOWINGDISCREPANCIESIN THE MEMBERANDDEPENDENTSDATA'S.

- THEY AREGOOD ANDTRUST US..

-HAZARD PAY,PROTECTIVEWEARS. New Entry

12/1/2013 20:21:55

JOSEPHHARROLD SULIT 4b [email protected]

FERNANDO AIRBASE HOSPITAL Government 1 11/16 to 29/2013 36 3 1 0 3 5 48 31 43 30

Since patientshere are mostoften times militarypersonnel or theirdependents,sometimes thePhilhealth deskofficer takes careof acquiring thesignature for thePART 2 of the CF1of members.

- erroneous dataon the member'sMDR (name,age,date of birth etc)- dependentsdeclared on theirMDRs are notlegal dependents(sponsoredmembers)- confusion on thePMRF as the solesource ofinformation of anapplicant memberwas resolved andcoordinated withthe PRO

- tried to explainwhy at times thememberscontributions arenot posted on oursystem (iCARES) -explained theupcoming bracketfor Philhealthcontribution for theFormal sector for2014 no issues

- Explained thechange inrequirements forPhysician who areapplying orrenewingPhilhealthAccreditation

- discussed thedifference betweenthe FFS schemeand the Case RatePayment schemeto members. - Informedmembers thepossibility ofimmediate benefitavailment if theywould pay for theentire calendaryear - reiterate that noweverything is 3/6mos requirementfor benefitavailment whethermedical or surgicalcase

The Hospital triesto comply with theNBB howeversometime somemedications areneeded to bebought outside ofthe hospital.

NOT YETIMPLEMENTINGACR

NOIMPLEMENTINGPOINT OF CARE

The hospital isaccommodating tothe CARESproject, theyprovided a sharedcomputer but atthe time of my staythere, there wasnot internetconnectiontherefore I was notable to access myiCARES accountand was not ableto release PCF1s. New Entry

12/1/2013 20:35:02 VENANCIO ALCAIDE 4b [email protected]

OCCIDENTALMINDOROPROVINCIALHOSPITAL Government 1 11/4 to 11/16 15 12 2 18 3 8 5 50 14 12

1. Sample copy ofMDR ( ofw,Private,Govetrnment, IPM,Lifetime) areposted in thebulletin board ofthe EmergencyRoom. In this waythe NOD caneasily recognizethe type ofmembership of theclients who areadmiited in thehospital. The NODalso thought onwhat are thenecessarydocuments neededin order to avail ofthe benefits, suchas MDR, properlyfilled-up CF1 for alltypes ofmembership,.Copy of ID for thelifetime membersand MarriageContract for theOFW members2. HospitalAdministration aregiven a cdcompilation ofPhilhealth Thesecd are played inthe OPD and ERdepartment.3. PMRF andPhilhealth Leafletsare given to thepatientscampanion orrelatives in order toencourage them toenroll in philhealth.Clients who arewilling to enroll onthe spot arereferred to theLHIO office fortheir payment.

1. Admitted clientswith lapses to theirpayments, arereferred to theLHIO office fortheir payments.2. Clients who arewilling to enroll aregiven PMRF andadvised to go theLHIO office fortheir automaticenrollment withoutany documentsneeded.3. 4P’S memberbut withoutPhilhealth number,These clients willbe given PMRF,together with thebasic requirementssuch as copy ofBirth Certificates,Marriage contractfor marriedmembers, Copy ofBirth Certificate ofchildren, Senior IDor if with Copy ofBirth Certificate forparents 60 yearold and above, andthe Xerox copy oftheir 4ps ID. Thesewill serve as theirMDR, in order toclaim of thebenefits inPhilhealth.

1. 3/6 in all casesis strictlyemphasized to thehospital. Clientswith lapses in theirpayment areadvised to pay atleast one year oftheir premiums toavail of thebenefits. Newmembers can alsoenjoy benefitsprovided that theypay at least oneyear of theircontributions none none

Reimbursementsare done 3-4months to theclients who boughttheir medicinesoutside thehospitsl

•Lack of laboratoryservices. Clientsneed to go to theprivate laboratoryand out of pocketexpenses alsohappen.•Charity beds arebeing used asNBB roomespecially in OBcases none

OccidentalMindoro ProvincialHospital expressestheir willingness toimplement thePoint of CareSystem. They areadvised to make aletter addressed tothe President andCEO of Philhealthexpressing theirwillingness. as peradvised by theRegional Office. none New Entry

12/1/2013 21:39:45 Barbie Joy Malinao 4b


Dr. DamianProvincial Hospital Government 1

11/14-16, 21-22,27-29/2013 39 27 6 48 17 32 174 250 335 335

There still a lot ofincorrect info andmispelled namesin MDR of Ingentsand SponsoredMembers.

There are patientsconfined everymonth with thesame illness(Hypertension).They want toexpand benefits ofphilhealth in thiscase of illness,

Lack of medicinesand supplies. This monthDDRPH includethe User's Fee ifCase rate benefits. New Entry

12/1/2013 21:20:48 VENANCIO ALCAIDE 4b [email protected]

STA CRUZCOMMUNITYHOSPITAL Government

PCF (Primary CareFacility) 11/18 TO 11/29 1 3 0 5 0 2 1 50 14 12 none

During wardrounds patientswho are nonmembers aregiven PMRF toenroll. and advisedto go to LHIOoffice for theirpayments.

Clients who arewilling to pay areadvised to go theLhio Office for thierpayments none none

high numbers ofRTS. The hospitaltogether with itsPhilhealth clerk aretaught on how toaccomplish thierclaim formcorrectly to avoidRTS in futureclaims

•Lack of laboratoryservices. Clientsneed to go to theprivate laboratoryand out of pocketexpenses alsohappen.•Charity beds arebeing used asNBB room none none none New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/1/2013 21:21:35 Gertrude Edusma 4b [email protected]

Balayan BayviewHospital & MedicalCenter Private 1

11-04 to 11-16/2013 8 3 1 7 28 4 46 6 40 44

The hospitalpersonnel givesinformation onphihealthrequirements andavailment rightafter admission.The patient canprepare therequirementsahead of time.

No problemsencountered aboutmembership.

Patients areinformed aboutIRR during rounds.Non members andthose with missedcontribution wereable to use thebenefit.

The receipts keptwere not visible.Clients had to goto ACA's forcopies. TheseACA's shoud beadvised toimproved theirofficial receipts tobe used for longterm.

Accreditation ofDoctors wasinformed to thephilhealth clerkand was followedup.

Benefit availmentwas explained toeach client andleaflets weregiven. Memberswere able tounderstood andmaximze theirbenefits withoutcomplainsencountered.

NBB is not appliedbecause it is aprivate hospital.

ACR no yetimplemented.

"Point of Care" notapplicable None Corrected Entry

12/1/2013 21:45:35 MARK ANTHONY VASQUEZ 4b [email protected]

ABORLANMEDICAREHOSPITAL Government 1 11/04-29/2013 16 11 3 46 18 12 106 62 70 58

1. ProvidePhilHealth patienton semi privateaccommodation aslong as rooms areavailable. NONE NONE

No AccreditedCollecting Agentavailable in thelocality. NONE

1. Incompletemedicines andmedical supplies.2. Incompletelaboratory exam.(Typhoid test,Blood chemistry)

Non compliant toNBB policy. NONE NONE NONE New Entry

12/1/2013 21:49:58 Barbie Joy Malinao 4b


Sta. Cruz DistrictHospital Government 1

11/4, 11,13,18-20,25, 2013 16 8 8 21 12 25 90

Some membershave difficultyupdating theirMDR because it isfar from the LHIO.

There is no doctorObstetrician in thishospital that is whyour members areforced to get theirprivate doctorespecially whenCesarean and Dand C are neededby our members.Indigents are myconcerned.

Lack of medicinesand supplies. User's fee areexcess of ourindigent memberseven if case rateNBB New Entry

12/1/2013 22:14:21 Gertrude Edusma 4b [email protected]

Apacible MemorialDistrict Hospital Government 1

11-18 to 11-30/2013 21 2 1 18 10 10 62 4 54 52

The philheathpersonnelentertainsquestions of thePhilhealthmembers.

I encounteredmany membershipproblemsespecially spellingand multiplemembership data.Another problemencountered mostof time is the wifeis a 4P's memberand the husbandhas a sponsoredphilhealth.

Members whohave missedcontribution andnterested nonphilhealthmembers areinformed aboutIRR.I had client whowas emplyed whomissed hispayment lastAugust 2013. Hewas able to use hisPhilhealth becauseof the 3/6 policy. Itwas also usedbecause it was notmentioned at theIRR that the 3/6months dosnt needto be consecutivemonths.

The ACA's receiptare not visible.Members arehaving a hard timeto get a duplicateof the receipts.They should beadvised to improvetheir receipts.

Almost all thepatients arereferred to aprivate doctor.Even those in theward rooms havetheir privatedoctor.I had a client whohas a privatedoctor but anotherdoctor gave birthto her.I submitted awritten report ofthe complains I gotfrom patients withtheir doctors.

Leaflets are givento each clientencountered.Clients lackinformationexpecting they canreimburse thewhole amountlisted in the leafletgiven. Benefitavailment formedicines &supplies is notmaximized.

NBB is not seen tobe practiced.Patients buy all themedicines andneeded supplies atthe hospital'sCoop. Theirpharmacy does nothave supplies.

ACR noot yetapplicable

Point of Care notapplicable.

No problemencountered. New Entry

12/2/2013 0:23:45 EBEAUVELIZA BLAY 4b [email protected]

LIPA CITYDISTRICTHOSPITAL Government 1 11/1/2013 11/30/2013 22 20 2 30 0 14 75 476 500 587

- There were a lotof erroneous onthe MDRespecially that ofthe sponsoredmembers. - Several memberswere unaware ofhow to adddependents andwho are their validdependents. - Non-memberswere unaware ofhow to becomePhilHealthmembers.

- Contributionsfrom past andpresent employerswere not reflectedin the member'scontribution historyas seen on theiCARES.

- The hospital staffwas supportive ofthe duties andgoals of PCARESNurses. - The clerks askedthe PCARESabout theirPhilHealthconcerns andshowed trust onalmost all of thegiven data by thePCARES. - There were fewtimes thatPCARES hadconfirmed to theclerk the member'sclaim on the non-acceptance of arequirement thatwas supposed tobe valid and theclerk had beenquite hesitant ofsuch even if theCARES alreadyconfirmed it withthe PRO. The clerkhad been tellingthat they had RTHclaims because ofthe same instance,but when asked ofthe said RTHclaim, she couldnot show one. Butstill, she'll agree atthe end with thePCARES andwould let themember avail ofPhilHealthbenefits. - The hospitalprovided WiFiconnection but nocomputer unit. Weused a mobilephone to provideour member theirneeded data fromiCARES. The WiFiconnection wasn'tvery stable.

- The hospitalpharmacy wasn'tfully equipped withmedicines andsupplies neededby the sponsoredpatients whichentailed them tobuy these outsidethe hospital usuallyat the hospital'scooperativepharmacy. - There had beensponsoredmembers whowere still asked topay for their bloodtests, Xray andultrasound examswhich were alldone inside thehospital. Theywere asked to payat the hospital'scooperativepharmacy. Butthere were alsomembers who toldus that they hadbeen permittedthat the chargesfor the said beexams be just partof the Philhealthdeductions. - The hospital hadno resident OB-gynecologists tocater for cesareansurgery and othersurgicalprocedures undercase rates thatmade oursponsoredmembers paymore than P20,000for each case ratesurgery as theywere left of nochoice but to havea surgeonconsidered to beprivate. - There were somecomplaining aboutthe said matter.According to them,PhilHealth had notbeen of help indecreasing theirfinancial burden.One evenmentioned " Sahalip namakatulong angPhilHealth ay lalopangnapapamahal."The other one said"Parang balewalaang PhilHealth."

- As observed, thehospital wasn'timplementing thePoint-of-CareEnrolmentProgram at themoment.

- An Android tabletshould be providedto all PCARES asnot all hospitalsprovide acomputer andinternet connectionfor iCARES'access. This willhelp us toimmediatelyprovide the serviceneeded by ourclients especiallyabout theirPhilHealth data. - provision ofboard and lodgingallowance- We are assignedto some hospitalsmore than 50kilometers awayfrom our residenceand would requireus not only one ortwo transportationmeans to get toour destination.Some would preferto stay just aroundthe hospital areawhich we are notreally familiar ofand others wouldchoose to travel forhours fromresidence tohospital and vice-versa. Any ofthese two maycompromise oursafety. Althoughthere are quite afew healthcareinstitutions thatvolunteer to giveus a place in theirhospitals toaccommodate ussuch as a vacantdelivery room withno bed or even afan, comfort of thePhilHealthemployee is inquestion whichmay also affect thehealth and eventhe quality of work.Staying in this kindof hospitalaccommodationmay also warrantour familymembers worryingabout our conditionfor the wholehospital stay. Ifthere will be boardand lodgingallowance forPCARES assignedto hospitals 30kmsaway fromresidence,PCARES will notcome to and fromwork exhaustedwhich maycompromisehis/hereffectiveness andeven health andsafety. New Entry

12/2/2013 4:28:46 RELAN MAPA 4b [email protected]

NORTHERNPALAWANPROVINCIALHOSPITAL Government 1 11/1/2013 11/30/2013 14 6 3 65 13 30 37 137 127 120

Erroneous recordcommonlyencountered tothose under theNHTS andsponsoredprogram.

Referring tomembers underthe formal sector,posting ofcontribution ondata basecommonlyobserved notupdated. Thus,forcing themember to submitadditionalrequirements(Certificate ofContribution) inaddition to theminimumrequirement beingrequired.

1. Under utilizationof NHIP benefits.Case rate cannotmaximize due tounavailability ofhospital supplies,drugs andmedicines.2.Misrepresentationby FurnishingFalse or IncorrectInformation.Changing/substitutionnot compensablediagnosis intocompensable onefor claimingpurposes.3. Chargingqualified patientsfor services(LABORATORY)which are legallychargeable to andcovered by theProgram.

Non - complianceto NBB policy. ALLqualified NHIPpatients spent outof pocket fordrugs/medicinesand laboratory. Corrected Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/2/2013 6:02:26 MADONA ALMERO 4b


N.L. VILLAMEMORIALMEDICALCENTER Private 2 11/04 to 9/2013 7 6 1 0 1 5 0

ErroneousMember DataRecord. Members'name reflected inMDR weremisspelled andsome of them haveincorrect birthdate. Multipledeclaration. A childconfined lastmonth used hisfather's Philhealthbenefits and themother wants touse her Philhealthfor thisconfinementbecause accordingto her, the childwas also herdependent in herMDR.

The list ofcontribution formost of the OFWand employedmembers was notupdated. Members thoughtthat they can paytheir premiumsthrough CARES.According to themit would be better ifwe could receivetheir payments forthem to save time.

A member inquiredregarding thestatus ofreimbursementsince hishusband'sconfinement lastmarch 2012.According to her,she always verifythe claim throughthe regional officeand the last timeshe inquired, shewas informed toverify her claim tothe hospital whereher husband wasconfined, but thehospital cannotprovide anyinformationregarding theclaim. CARESchecked the statusof reimbursementthrough theregional office andfound out that theclaim was not yetpaid because itwas sent back tothe hospital due tolack of a laboratoryexam requirement.She waited for solong withoutknowing that it wasthe reason for theunpaid claim formore than a year. Members consultCARES regardingstatus ofreimbursement.According to them,they were not ableto receive theirBPN though theywere confined ayear or severalmonths ago.

The hospitalinquired regardingthe implementationof All case ratesand its guidelines.

CARES wasstationed at theinformationdepartment, thereason for clientsto ask questionsnot related toPhilhealth. Theyinquired regardingthe schedule ofphysicians, roomof the patient andother concerns. New Entry

12/2/2013 6:22:36 MADONA ALMERO 4b


SAN ANTONIOMEDICALCENTER Private 2 11/11 to 16/2013 12 9 1 0 2 2 0

ErroneousMember DataRecord. Members'name reflected inMDR weremisspelled andsome of them haveincorrect birthdate.

Members postedcontribution wasnot updatedthrough icares Confusionregarding the 3/6months ofpremium paymentfor benefitavailment.

Employedmembers wherealways required toprovide the signedCF1 though theypresented thecertificate ofcontributionoriginally signed bythe employer.According to themedical clerks,there is noinstance where inshe allowedcontribution of theemployedmembers alone toavail of Philhealthbenefits. Members consultCARES regardingstatus ofreimbursement.According to them,they were not ableto receive theirBPN though theywere confined ayear or severalmonths ago. The medicare clerkinquired on how toavoid deniedclaims for dialysispatients. She wasasking on apossible way forthem to avoidunpaid claims dueto exhaustedbenefits. For her,the confinementhistory of the clientor the availmenthistory should beupdated.

The hospitalinquired regardingwhen will be the Allcase rates beimplemented. New Entry

12/2/2013 7:04:09 MADONA ALMERO 4b

[email protected] Roving OSPITAL NG LIPA Government

PCF (Primary CareFacility) 11/18 to 29/2013 18 7 0 3 23 7 59 78 175 175

ErroneousMember DataRecord. Members'name reflected inMDR weremisspelled andsome of them haveincorrect birthdate. 4ps membersinquired why theirgrandchildrenaren't covered/allowed forPhilhealth benefits. 4ps members,when checkedthrough icareshave existingPhilhealthmembers. Non memberswere advised toregister forPhilhealth but theychose to use themembership cardsponsored by thelocal government.

Contributionsposted at icareswas not updatedespecially foremployedmembers.

The hospital catersfree executivecheck up for seniorcitizens. Some ofthe membersthought thatexecutive check upwill be covered.There was aninstance where inrequirements forbenefit availmentwas checked andfound out that itwas for executivecheck up so theclient wasinformed regardingthe case. Upon room toroom visit, i wasable to talk withpatients forexecutive checkup. According tothem, it was free ofcharge and theywere just informedto present theirPhilhealthrequirements.They were advisedto stay for 24hours and theywere also given 1small sack of freerice. It was not yetconfirmed if thehospital was filingthe executivecheck up cases forPhilhealth but mostof the observationslead it there. A client inquiredregardingregistration forPhilhealth becauseshe wants to use itfor executivecheck up. Theclient wasinformed that itwas notcompensable butthe client insists onapplying forPhilhealth becauseaccording to her,she knew a lot ofclients who wasable to avail of thefree executivecheck up providedthat theypresented thePhilhealthrequirement. Sponsoredmembers were notadvised to attachthe receipts ofmedicines orlaboratoriesbrought or doneoutside of thefacility though Nobalance billing wasimplemented.

No Balance Billingwas implementedby the hospital.Clients do nothave an out ofpocket spendingfor benefitavailment in mostcases.

The hospitalinquired regardingthe implementationof All case rates. New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

12/2/2013 8:58:52 CARMI FABICULANA 4b [email protected]

MALIPAYONDISTRICTHOSPITAL Government 1 11/4, 5 &6/2013 1 0 0 1 0 1 3

Incorrect input ofdata of mostSponsored/Indigentsmembers and theirdependents.

Non-availability ofcollecting agent orBayad center inthe municipalitythus inability to payfor their quarterlyremittances. None.

Few admissions. Confusion of thephilhealth clerk inattaching anofficial receiptversus salesinvoice receipt forphilhealth claimfiles for membersreimbursement.

Very fewadmissions andmostly were forobservation only. Most Philhealthmembers assumedof getting thewhole amountwritten on the BPNthey received. According toHospital staff mostclients complainedof no Philhealthreimbursementreceived even ifthey attached nofficial receipt ofwhat they boughtoutside thehospital.

Not complaint dueto unavailability ofall medicinesneeded for acertain case/illnessfor confinement. none. none.

Extension ofPhilhealth Caresproject. Moretrainings/forumsfor us CARES. ON TIME andADDITIONALtravel allowanceswhen we had ourduty at far flungareas. New Entry

12/2/2013 9:45:25 CARMI FABICULANA 4b [email protected]

DON MODESTOFORMILLEZA SR.MEMORIALHOSPITAL Government 1 11/7 to 30/2013 28 11 1 32 1 23 96 54 74 69

Do ModestoHospital do have ateam (Doctor andthe Pharmacist) inplanning andstrategize inhaving enoughsupply ofmedicines forphilhealth use ofall philhealthmembers until theywould come upwith theimplementation ofNBB policy.

Incorrect input ofmembers/dependentsdata. Inactivemembership ofsomeSponsored/Indigentmembers,previouslyemployed memberand an IPPmember who didn'tcontinue to paytheir remittances.Encouragement foractivating it wasdone.Contributions andwhere to pay wasfurther explained. Some members donot have adeclareddependent.Updating ofmembers datarecord wasexplained.

Non-availability ofcollecting agentsor bayad center ineach municipality. Loss of receipt ofsome IPPmembers. Negative feedbackon the increase ofphilhealthcontribution for thenext year. none.

No certainPhilhealth ward forphilhealthmembers. Not enoughPrivate roomswhich formal,informal andlifetime memberslike/prefer to beplaced on acomfortable andhave a privacywithin theirconfinement. Some philhealthclaim files wasforwarded to PROby the medicalclerk even if thepapers was lacking(just not to exhaustthe 60 days givento the hospital toprocess/completethe claim files)thus a reason forhospital's RTHfiles.

Non-availment ofsome Philhealthmembers due tounprocessedpapers andconfinement forless than 24 hours. Exhaustion of 45days allowancebenefit of asponsoredmember. Philhealthmemberscomplained ofhaving a long timein waiting for theirreimbursement.Explanation on theprocess or flow oftheirreimbursementwas done. Hospital do nothave an Xray techreliever thuspatients who needto undergone Xrayhad a hard time intraveling toprovincial hospitaljust to undergowith the saidprocedure and goback again to DonModesto.

DMFSMH is notcomplaint with theNBB policy. Theydo have medicinesbut the supply isnot enough tocover all philhealthmembers beingconfined in thesaid hospital.Philhealthmembers need tobuy other medicineoutside thehospital andsecure an officialreceipt forreimbursement.

Not yetimplemented. Not implemented.

Provision of PCwith internetconnection in orderto access theicares. Moretrainings/forumsfor us CARES. Extension ofservice as CARES. ON TIMEALLOWANCES. New Entry

12/2/2013 11:04:55 John Joseph Rivadenera 4b [email protected]

Paluan CommunityHospital Government 1 11/4 to 15 /2013 6 0 0 3 1 9 12 40 3 0

Correction ormispelled appearson the MDR of themembers data andtheir dependents, Sometimes thepatients are notofficially declaredin the MDR.

Sometimes they'rehaving a problemregarding theirpremiumcontribution orpayments in orderto avoid missquarter especiallyto self employed,Because there isno collectingagency, orcollector for anypayment in PaluanCommunityhospital. Theyhave no choice totravel atleast 1-2hours before theyget in LHIO and itwas located toMamburaoOccidentalMindoro.

They are always incontact regardingthe policies,updates, and otherconcerns aboutclaims and otherproblems orissues.

Not all the caserates package arecovered oravailable in PaluanCommunityHospital becausesometimes thelaboratory or otherexams are notavailable. Sometimes theclients are notsatisfied to thehospital services.Because of lack ofmedicines andpoor facility.

Out of pocketexpenses stillhappens in PaluanCommunityHospital asverbalized by theclients or themembers.Insufficientmedicines supply.

Not implementeduntil now

Not implementeduntil now

May we requestthe feedback fromthe IT regardingthe request letterof portal system inPaluan CommunityHospital. New Entry


PR)Sponsored

Member Non-Member



lectures,etc.



member/dependent







ONE

4b (responses)

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