Over 100 PhilHealth-accredited centers halt granting of special privileges to dialysis patients

Marje Pelayo   •   October 26, 2020   •   317

MANILA, Philippines — Advocate group, Dialysis PH Support Group Incorporated, is calling on the Philippine Health Insurance Corporation (PhilHealth) to address the concerns of its 42,000 members across the country. 

According to the group’s founder and president Reynaldo Abacan Jr., they have been receiving reports from several members that some PhilHealth-accredited dialysis centers are no longer granting them special privileges.

Under the Bayanihan to Recover Act (Bayanihan 2), their dialysis treatment that is being shouldered by PhilHealth should extend until December this year.

“Iyong natanggap naming email mula sa aming mga members, ipinakita nila na mayroong PhilHealth clerk from Region 4 or Batangas na in-email ang bawat center na hindi muna maipapatupad ang special privilege o ang continous dialysis dahil kailangan daw nila ng implementing guidelines or circular,” Abacan said.

(Translation: We received an email from some members citing that a PhilHealth clerk from Region 4 or Batangas sent a mass email to other centers instructing them to stop the special privilege program or the continuous dialysis privilege because they need to receive first an implementing guideline or circular.)

Under PhilHealth’s regular package, a dialysis patient is entitled to 90 dialysis sessions a year which is only up to the month of August. The succeeding months, Abacan said, is shouldered by the patients. This is the reason why they are asking PhilHealth to extend the privilege up to 156 sessions to cover the whole year. This request has been hanging since the year 2015.

They argued that even with special privilege, they are still shelling out additional cash as PhilHealth only covers P2,600 while other centers are charging more than the said amount.

Abacan said there are about 100 dialysis centers across the country that have already suspended the so-called special privilege which has now affected some 30 to 70 patients per center already. 

“Na-cancel ang iba. Iyong iba nakagamit na tapos biglang na-cancel, biglang na-hold. Nagulat iyong mga pasyente. Kasi karamihan sa amin ubos na talaga ang Philhealth at kailangan na nilang magbayad (Others were cancelled. Some were able to start the treatment then all of a sudden, it was cancelled to their surprise. Most of us have used up all PhilHealth discounts so we really need to pay in cash),” he lamented.

“Magkano? Nasa P3,000 kada treatment para lamang maisalang sa dialysis, (How much? It’s P3,000 per treatment that you need to pay just to get into dialysis)” he added.

What worries them, Abacan said, is the possibility that the services they are entitled to are getting caught in the crossfire of issues hounding PhilHealth.

“Ngayon dahil tayo ay under ng pandemic napakahirap ng buhay ngayon. Marami sa amin nawalan ng trabaho, nawalan ng pagkakakitaan (Because of this pandemic, life is tougher. Many of us have lost their jobs, lost their sources of income),” Abacan noted.

“May mga agency na hindi na nagbibigay ng tulong so naging malaking problema sa amin talaga ito (There are agencies that no longer extend assistance, so it has become a big problem for us),” he added.

For now, the group is awaiting PhilHealth’s response to their letter regarding the matter. MNP (with reports from Rey Pelayo)

PhilHealth urged to fast track issuance of circular on extension of hemodialysis treatment

Marje Pelayo   •   November 18, 2020

MANILA, Philippines – An advocacy group is calling on the Philippine Health Insurance Corporation (PhilHealth) to expedite the release of a memorandum circular regarding the extension of coverage for hemodialysis patients from 90 to 144 sessions.

“Ang problema kasi dito ngayon kaya namin hinihiling ito kasi walang pera ang mga tao ngayon na ipapaluwal doon sa treatment. Ang nangyayari hindi sila talaga nakakasalang [We are asking for this now because the problem is many patients have no money to support their treatment. The tendency is to skip the treatment],” Dialysis.PH president Raynaldo Abacan Jr. said.

Just recently, PhilHealth President and CEO Atty. Dante Guerran announced the supposedly good news which is part of the provision of the Bayanihan to Recover as One Act or Bayanihan 2 law.

It gives patients the privilege for their much needed hemodialysis until December 31 of this year.

But according to Dialysis.PH, many dialysis centers do not honor Atty. Gerran’s pronouncement and demand a formal circular.

Magandang balita. Maraming nag-comply pero ang nakakalungkot meron pa ring mga centers na hindi nag-comply [That’s good news. Many have complied but the sad thing is many centers still did not],” Abacan said.

In his announcement, Gierran said he ordered all PhilHealth regional offices and other health facilities to accept dialysis patients even if they have finished the initial 90 sessions. 

He added that patients may reimburse from PhilHealth any amount that they paid outside of the 90 days free sessions.

The agency said it is now drafting the memorandum circular for that matter.

PhilHealth to cover hemodialysis up to 144 sessions until Dec. 31

Marje Pelayo   •   November 17, 2020

MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) has decided to continue the coverage for hemodialysis patients to 144 sessions until the end of the year.

“The PhilHealth Board approved on November 11 continuing coverage of hemodialysis sessions beyond 90-session limit to maximum 144 sessions which can be availed of until December 31, 2020,” the state insurer said Monday (November 16).

The agency said it will immediately issue guidelines through a Circular that will direct all regional offices and concerned healthcare facilities to continue honoring availments beyond the 90-session limit as duly prescribed by a licensed physician.

Meanwhile, hemodialysis patients who paid for their sessions can file their claims at the nearest PhilHealth office.

The agency has not detailed when the circular for guidelines would be released.

Gierran assures suspension of execs won’t affect PhilHealth functions

Robie de Guzman   •   October 29, 2020

MANILA, Philippines – Philippine Health Insurance Corporation (PhilHealth) president and CEO Dante Gierran on Thursday said the agency will continue rendering its services and functions despite the suspension of eight of its executives.

“PhilHealth assures its members and stakeholders that its mandate and services shall continuously proceed unhampered notwithstanding the challenges that it is currently facing as part of the necessary reforms needed to be undertaken to further improve its services toward the implementation of Universal Health Coverage (UHC) for all Filipinos,” Gierran said in a statement.

Gierran issued the statement after the Office of the Ombudsman ordered the suspension of eight PhilHealth officials over the alleged anomalous release of funds under the Interim Reimbursement Mechanism Policy.

Among those ordered suspended by the Ombudsman are Chief Operating Officer Arnel de Jesus, Executive Vice President Renato Limsiaco, Senior Vice President Dr. Israel Pargas, Area Vice President Gregorio Rulloda, Benefits Administration Section Head Dr. Imelda Trinidad De Vera-Pe, Manager Lolita Tuliao, Fiscal Examiner Gemma Sibucao, and Fiscal Controller Lailani Padua.

The Ombudsman said the suspension order is in relation to the investigation being done on administrative cases of grave misconduct, serious dishonesty and conduct prejudicial to the best interest of the service.

“PhilHealth Management acknowledges the recent Order of the Office of the Ombudsman putting several of its Executive Officers and Personnel under preventive suspension for grave misconduct, gross neglect of duty, and conduct prejudicial to the best interest of the service. We shall abide and implement the suspension Orders accordingly,” Gierran said.

“PhilHealth Management maintains the constitutional rights of its Officers and Personnel on its presumption of innocence until proven otherwise,” he added.

“We trust that the Honorable Office of the Ombudsman will accordingly observe objectivity, justice, and fairness, and allow our concerned Officers and personnel the due process to properly explain and defend themselves,” Gierran further stated.

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