Suspicious PhilHealth episodes

/ 05:02 AM June 21, 2019

I have long felt that the PhilHealth system is vulnerable to scams perpetrated by employees of the Philippine Health Insurance Corp. (PhilHealth) themselves. The Inquirer headline, “PhilHealth insiders behind double claims” (6/19/19) confirms my suspicion.

Some years back, I was confined at one of the best hospitals in Metro Manila. When I paid the bill, I was told my PhilHealth benefits had been deducted from the total bill. A check of the charges, though, showed that no deduction for PhilHealth benefit for doctor’s fee was made.


I found out later that the PhilHealth people at the hospital had filed a claim for doctor’s fee, but instead of the check being made to my favor, it was made to the favor of the doctor. I could not help but suspect that they had intended to tell the doctor they had made a mistake and deceive the doctor into giving them the cash equivalent, supposedly to be given to me. My persistence foiled their chicanery.

My daughter had dental surgery in the same hospital. When she filed a claim for PhilHealth benefits, the claim was rejected (verbally) because the surgery was performed in the dentist’s clinic in the hospital, not in the hospital’s operating room. I have the feeling the PhilHealth people at the hospital had filed a claim in the name of my daughter, but somehow got the cash reimbursement.


Five years ago, my cardiologist said I had to undergo an open-heart surgery. The cardiologist said her team of doctors could perform the operation in a world-class hospital for a package fee.  I agreed.

When I filed a claim for PhilHealth benefits, I was told the doctors availed themselves of my benefits. If so, then the doctors misrepresented their fee as a package deal, as my PhilHealth benefits compensated for the supposed discount given me. Or did the PhilHealth people avail themselves of my benefits?


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