DOH, PhilHealth asked to reconcile conflict in seniors’ hospital discount
ROXAS CITY – There is a need for the Department of Health and Philippine Health Insurance Corp. to reconcile the conflict in their guidelines on the granting of the 20 percent discount for senior citizen patients admitted in private hospitals, said Jessie Contreras, vice president of the Private Hospitals Association of the Philippines.
Contreras, administrator of Capiz Emmanuel Hospital, said there is a conflict between DOH Administrative Circular No. 177, series of 2004, amended to Administrative Order No. 171, series of 2004, and PhilHealth Circular No. 02, series of 2002.
“We are waiting for the guidelines to be issued by the DOH in giving the senior citizens 20 percent discount in private hospitals,” he said, adding that the PHAP is more amenable to the DOH’s than PhilHealth’s guidelines.
Under the DOH guidelines, a hospital bed in a private hospital is deemed medically necessary to diagnose and treat an illness or injury and is granted 20 percent discount provided that the smallest available room and board accommodation shall be deemed medically necessary.
If there is no available smallest room and board accommodation at the time of confinement, all other room and board accommodations shall only be granted with a discount equivalent in the amount of 20 percent discount in the smallest room and accommodation.
On the other hand, the PhilHealth circular states that the 20 percent discount should be applied on the rate of the room actually utilized by the patient and should not be limited to a discount equivalent in the amount of 20 percent discount in the smallest available room and board accommodation.
Meanwhile, Contreras said he supports the sentiments of PHAP National President Rustico Jimenez in a resolution, asking the PhilHealth not to delay its reimbursements of hospitals for patient claims although refunds from PhilHealth is no longer a problem among hospitals in Western Visayas.*
