THE Zambales Integrated Provincial Health Office (PHO) has announced the strict adoption and implementation of PhilHealth’s No Balance Billing (NBB)/Zero Balance Billing and No-Co-Pay policies in all hospitals run by the Department of Health (DOH) in the province.

In a memorandum issued by Dr. Noel C. Bueno, Provincial Health Officer II, and approved by Gov. Hermogenes Ebdane Jr., the PHO instructed all hospitals, physicians, and consultants under the provincial government to comply with the PhilHealth directive.

According to Bueno, PhilHealth Circular No. 2020-0024 mandated that all PhilHealth members, regardless of category, are entitled to “No Balance Billing / No Co-Pay, if confined in a ward or basic hospital accommodation.

“This means that indigents, sponsored members, kasambahays, senior citizens, PWDs, solo parents, and even regular/contributing members shall not be charged any additional fees beyond the PhilHealth case rate when admitted to ward or basic accommodation,” Bueno said.

However, patients who choose to be admitted in private or pay rooms won’t be covered by the program, and “may be billed for charges beyond PhilHealth coverage, including differential room rates and professional fees,” Bueno clarified.

Bueno also pointed out that compliance with the PhilHealth circular will be monitored by the PHO and that violations by government physicians or consultants would result in sanctions ranging from reprimand for the first offense, suspension for second offense, and dismissal from service or termination of contract for the third and final offense.

Violations by hospitals and other health institutions, meanwhile, may incur suspension or denial of PhilHealth claims reimbursements, or review of accreditation status, with the final sanctions to be determined by PhilHealth as the accrediting body.

Any amount collected from patients in violation of the NBB/No Co-Pay policy must be refunded to the patient within 30 days upon verification of the complaint, Bueno added.

According to PhilHealth, the free hospitalization program covers services that include room and board, medicines, laboratory tests, and professional fees.

Victims of accidents or road crashes are said to be covered by the program, as long as the accident was not their fault and they are admitted to a DOH hospital or trauma center. Patients under the influence of alcohol at the time of an accident, however, are not eligible for free hospitalization under the program.

PhilHealth has also stressed that the four specialized hospitals run by government-owned and controlled corporations—National Kidney and Transplant Institute, Lung Center of the Philippines, Philippine Heart Center, and Philippine Children’s Medical Center—are not covered by the program. – Taktikom News & Features