Unresolved PhilHealth vs Butuan hospital case deprives police officer of medical benefits

BUTUAN CITY (MindaNews / 21 Feb) – Because of the pending case filed by the Philippine Health Insurance Corp. (PhilHealth) against a hospital here over alleged fictitious 29 patients has remained unresolved for over a year, a police officer has been deprived of his claim for medical benefits for a crucial surgical operation.

The Butuan Doctors’ Hospital. Photo courtesy of Google Street View

Corporal Paul Fritz Silla, who is being tormented by avascular necrosis or dead bone, was denied of his PhilHealth claim after the country’s health insurer filed charges against the Butuan Doctors’ Hospital (BDH).

Silla was obliged to pay the pricey second surgical operation performed by Dr. Jerome Asuncion, head of the BDH’s Advanced Wound Care Center (AWCC), after the police officer was told that the case was already filed, prompting hospital administrators to temporarily suspend PhilHealth services. (AWCC, located inside the BDH compound, specializes in wound care.)

PhilHealth had accused BDH of a consolidated case of 29 counts of claims for non-admitted or non-treated patients and breach of warranties and accreditation.

Silla had been treated by Asuncion for months and had been enjoying the benefits of PhilHealth in his six years of service in the police force except for the second operation.

Two other former patients were shocked to find out that BDH is already facing charges, which may lead to PhilHealth’s suspension of the hospital’s accreditation.

Juniph Monteclaro, a diabetic patient whose toe was cut off to prevent the spread of infection to other parts of his body, had been frequenting Asuncion for continuous medication for six months availing of PhilHealth benefits.

His wife Lenette expressed apprehension about the pending case, which particularly singled out Asuncion.

“He is a very accommodating physician who attends to his patients even in the evening,” Lenette said based on her observation at one time when they came to visit AWCC last year.

Another diabetic patient, Alicia Enriquez, 66, said she had been seeing Asuncion as an outpatient for two months after she suffered infection on her hand.

She said doctor’s fees and medicines during the treatment at the AWCC were covered by PhilHealth while the rest she personally bought over the counter at the pharmacies in Cabadbaran City, where she lives and runs a small eatery for her livelihood.

She disclosed that a PhilHealth personnel came to see her to confirm if she was really a patient of Asuncion.

“Why are they doing this to the hospital? I really felt bad about it,” Enriquez said in an interview.

Edwin Elacion, a retired police officer who was treated at the AWCC for his broken legs due to a motorcycle accident in June 2018, said in a mobile phone interview early last month that he was an outpatient who frequented BDH for over a month for continuous dressing of his wound and putting stainless steel for bone surgery.

Elacion, 62, a former police inspector, recalled it was the first time he availed of PhilHealth benefits in his 35 years of service as a police officer.

He admitted that PhilHealth personnel came to him not to confirm if he was treated at the hospital but rather asked him if Asuncion, head of BDH’s AWCC, charged his treatment with an overpriced billing.

“Dr. Asuncion treated me well and even given me with imported medicines to make sure I will be totally cured,” he said.

Mariaden Ligotan, whose son Nissan was admitted at the BDH for four months and two weeks after both of the bones of his legs were crushed by a fallen tree, said they availed of his son’s PhilHealth membership that helped a lot in settling their bills which reached more than P500,000.

Asuncion, she said, also advised that Nissan would just be an outpatient to reduce medical bills after he underwent a major surgical operation during which his left leg was amputated and the right leg placed with stainless steel for support.

“He is a good man and understands the situation of poor patients,” the mother said of Asuncion.

MindaNews attempted to get the side of the local PhilHealth office but officials refused to comment pending decision on the case.

The PhilHealth Arbitration Office in Pasig City has charged BDH with consolidated case of 29 counts of claims for non-admitted or non-treated patients and breach of warranties and accreditation.

PhilHealth also mentioned performance commitment under sections 151 and 160 of the 2013 Revised Implementing Rules and Regulations of Republic Act (RA) 7875, which enacted the PhilHealth program as amended by RA 9241 and RA 10606.

The amended RA 9241 already provides universal health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the country while RA 10606 has mandated PhilHealth to provide health insurance coverage to all Filipinos. (Chris V. Panganiban / MindaNews)