imyeyes-banner-sqIn My EyesBy Edward B. Antonio

Philhealth and Tolentino Hospital (Last of 2 parts)

And so, after 4 days of confinement at the Tolentino Clinic and Hospital, the child was ready for release. His father was expecting that if he didn’t get a zero balance, he would just be paying a little amount. As a government employee, he was aware that the Philhealth package for pneumonia is P15,000 for moderate risk and P32,000 for high risk pneumonia.

One of his co-workers informed him a day before: “Sir, you will probably get a zero-billing like me. When my child had pneumonia, too, we also confined him at a private hospital for 4 days. We had zero billing as the Philhealth package for pneumonia is P15,000.”

But it did not turn out to be like this.

When the Statement of Account (SOA) was presented to him, his total bill amounted to P18,570.

The draft SOA, presented to him by the chief nurse and the nurse assigned for the day stated that his total net balance was P8,070 after deducting the Philhealth pneumonia package benefit of P10,500. So, it’s P18,570 less P10,500 equals P8,070.

“Why only P10,500 Philhealth benefit when in fact the Philhealth pneumonia case rate benefit is supposed to be P15,000?” the father inquired.

“Sir, it’s because hospitals vary in categories and our hospital is just classified as an infirmary. Infirmaries have lower Philhealth benefits for Philhealth patients. For other answer to your queries, please come back tomorrow so you can get your official SOA and then our Philhealth secretary can answer all your queries regarding your Philhealth.”

The father examined the draft SOA. The bigger amounts charged were: 5 administration of Ceftriaxone vial (P5,000), room/ward (P4,000) and doctor’s fee (P4,000)

“Ah, P1000 per day pala ang doctor’s fee,” he said.

“That’s our rate here, sir,” the chief nurse said. “The doctor’s fee per day is equal to the room rate per day.”

“Ah, I did not know that.”

The father examined the other amounts charged: 17 nebulization (P1,700). chest X-Ray (P450) while the rest included other medicines, hospital supply, laboratory, nursing fee and miscellaneous fees.

He was informed that the official SOA would be available the following day as it was already 6:00 PM and the employee in-charge of the SOA had checked out.

The following day, the father went back to the hospital to get his SOA and this time, he was entertained by the pretty, couteous and polite Philhealth secretary who gave him the SOA and medical certificate. The latter cost P50.00.

She just reiterated what the nurses explained to him the evening before. There were no further issues raised as the secretary seemed very adept when it came to Philhealth matters.

“Sir, talagang infirmary pa lang ang category namin dito kaya mas mababa ang Philhealth benefits ng aming mga pasyente na Philhealth beneficiaries. Siguro ‘yong P15,000 pneumonia Philhealth benefit ay applicable sa Level 1 pataas na ospital,” she said.

Ah, okay, bakit di pa ma-classify na Level 1 ang Tolentino Hospital, tutal malaki naman ito?”

“Kasi, sir, we lack the number of nurses, some medical services…” she said, but the father said he could no longer recall the other “lackings.”

I turned to my google search and here’s I found out, fellas.

John Tobins who worked at hospitals said that an infirmary is a facility for care and housing of the sick within a larger institution—school or prison, for example. An infirmary typically has limited capabilities—no operating rooms, for example—and is not intended for patients requiring lengthy stays, complex treatments or full-service diagnostic facilities.

“Infirmary is a somewhat imprecise label. An infirmary might, in fact, be a small hospital with sophisticated capabilities, and some large, free standing hospitals might be called infirmaries,” Tobins said. 

And what are the other level categories of hospitals according to Philhealth?

A Level 1 hospital is also an emergency hospital. It has initial treatment for cases that require immediate treatment, provides primary care for prevalent diseases in the area. It has general medicine, pediatrics, minor surgeries, and non-surgical gynecology, primary clinical laboratory, pharmacy and first level radiology. It is also a nursing care for patients needing minimal supervised care.

A Level 2 hospital is a non-departmentalized hospital. It has general medicine, pediatrics, surgery, anesthesia, obstetrics and gynecology, first level radiology, secondary clinical laboratory and pharmacy. It has nursing care for patients needing intermediate supervised care.

A Level 3 hospital is a departmentalized hospital. It has all clinical services provided by Level 2 hospitals with specialty clinical care. It has tertiary clinical laboratory, pharmacy, second level radiology. It also has nursing care for patients needing total and intensive care.

A Level 4 hospital is a teaching and training hospital. It has all clinical services provided by Level 3 hospitals. It has specialized forms of treatments, intensive care and surgical procedures. It also has tertiary clinical laboratory, third level radiology and pharmacy. It has nursing care for patients needing continuous and specialized critical care.

Now based on the Philhealth package benefit between an infirmary (based on the matrix posted on the nurses’ station at the Tolentino Clinic and Hospital) and a Level 1-4 hospital, here are some of the differences: Pneumonia: Infirmary: P10,500 Level1-4: P15,000 to P32,000; Dengue Fever: Infirmary: P7,000 Level1-4: P10,000 to P16,000; Typhoid Fever: Infirmary: P7,000 Level 1-4:P10,000; Asthma: Infirmary: P6,300 Level 1-4: P9,000 etc. etc.

So, what can this government employee father say of his experience with Tolentino Clinic and Hospital regarding its services and Philhealth benefit experience?

“Oh, everything is okay. It’s a nice hospital and Dr. Tolentino is a very good doctor, and a very good conversationalist, too. All of the nurses there are very polite and courteous. What is necessary is that my child is already okay. All my comments to this hospital are positive and someday, if we have health problems again, this hospital would be one of the first in our list,” he said.

So, all’s well that ended well, fellas.

At least from this column, we all learned something new from Philhealth and hospital categories.

And Philhealth benefits, too.

As for Tolentino Clinic and Hospital, kudos to all of you there.

And good luck to your goal of advancing from an infirmary to a Level 1 hospital.

God bless.