Failed Philhealth Availment

I gave birth last October 16, 2011 in a private hospital in Calamba, Laguna..

I thought all the while that newborn screening and immunizations of my newborn baby shall be automatically covered by Philhealth but on the contrary, I paid cash.

Well, I just thought that maybe it was not an automatic deduction because my daughter was not yet included in my Philhealth's MDR list of beneficiaries and that I'll just have to update my MDR upon release of my daughter's birth certificate, which, the hospital said, will be available within a week..

Unexpectedly, the release of my daughter's birth certificate took almost a month.. I immediately went to the nearest Philhealth branch to update my MDR so I could file the necessary documents to the hospital for reimbursement of my expenses.

But unexpectedly again, upon submission of documents, the Philhealth staff in the hospital informed me that there's a new Philhealth policy on newborn screening called NEWBORN HEARING SCREENING TEST. I will not be  able to avail of the medical reimbursement if my baby has not undergone this test.

I told her that if it is a policy, it should have been done while we were still confined in the hospital, right?

But the staff told me that the hospital has no capability of newborn hearing screening test, and that I must inquire from other hospitals.. (at the back of my mind, I asked why did the government made this test compulsory if not all the hospitals are capable of doing it? And if this private hospital does not have such capability, how much more with other small private or government hospitals?) Oh well, rules are rules and there's nobody to argue about..

To make the long story short, I had my baby's newborn hearing screening test from another private hospital and went back to the Philhealth Section of the hospital where I gave birth to. It was December 5 already, nearing the 60-day deadline for filing of Philhealth claims.

February 2012, I received a notice from Philhealth main branch indicating that my claim was disapproved because (1) they received my documents December 22 already (beyond the 60-day deadline); and (2) there was no attached receipt of doctor's professional fee.

I felt so frustrated that time; I felt as if the hospital staff where I gave birth to was so incompetent and all.. But I still tried to appeal as the Philhealth letter indicated that I should submit the required documents upon appeal.

And so last February 17, 2012, I went back to the hospital to submit the notice from Philhealth and to inform them that Doctor's Professional Receipt is needed for my appeal. The Philhealth staff took my number and told me thet they will be the one to forward the necessary documents to the Philhealth Office.

Guess what happened next? I called the hospital a month after submission (that was March) but they told me the staff in-charge was not there and that they'll call me for updates..

Last April, I made another follow up at the hospital - they told me they're gonna have to verify the status at Philhealth Office and they'll call me - but they didn't.

It was May 15 already and upon follow up, I still heard the same line from the hospital staff "we'll call you".. My patience is becoming thin already but still, I'm hoping that soon, I'll be able to see the light.

I'm not sure but perhaps there are also other Filipinos out there who have experienced difficulty in claiming medical benefits.. The bureaucracy in our country is really not good..

Well, I hope time will come when medical and other social benefits would become as good as in other countries..