China Corona Virus Outbreak

[dr. d]

How ironic , theres a hospital in bulacan named skyline.

talagah... i didn't know that!

[papi smith]

I'm enrolled din sa ICTSI program via Healtnow... pero as an dependant. Problem ko ngayon I already got my shots via Ayala and LGU program. Di pde refund...

Me too, I am scheduled for my 2nd shot on October sa LGU. Sa tumal ng dating ng vaccine, hindi malayo na abutin ng April ung sa Healthnow, so booster shot na sya.

[glenn_duke]

talagah... i didn't know that!

And they also charge skyline
When my son went there because of covid19 symptomes, he was turned away, because they dont have the anti viral drug, but before he can leave he has to pay 30k for 1 hour oxygen, 1 hour sitting in a monobloc chair, and for 5 minutes time of the nurse that took his details.

[_Cathy_]

Baka anti viral at anti inflame drugs ang nakamahal.
May mga private hospital din sa bulacan na balasubas mag charge.

P17k nga daw yung RT PCR

[glenn_duke]

P17k nga daw yung RT PCR

Kaya dimo masisi philhealth kung ayaw irefund mga private hospitals, daming over charging.

[dr. d]

Kaya dimo masisi philhealth kung ayaw irefund mga private hospitals, daming over charging.

but may mga inosenteng uspital na nadadamay...

i know of a number of doctors who are contemplating on charging their own PFs and not relying on philhealth anymore.

ultimately, yung pasyente ang kawawa.

philhealth should re-think its approach to its problems.
as an aged teacher once advised us,
"the more successful crimes are when there are cooperating parties from both sides."

[cast_no_shadow]

but may mga inosenteng uspital na nadadamay...

i know of a number of doctors who are contemplating on charging their own PFs and not relying on philhealth anymore.

ultimately, yung pasyente ang kawawa.

philhealth should re-think its approach to its problems.
as an aged teacher once advised us,
"the more successful crimes are when there are cooperating parties from both sides."

The policy aims to deter those who are doing fraudulent / unethical acts. There will be a due process, hindi naman daw arbitrary.

If meron lang red flags observed then temporarily payment will stop and a deeper validation and checking doon sa mga submitted claim nung identified facility / professional.

In a way this is done to safeguard the public fund para mas sustainable yung program.


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[papi smith]

Kaya dimo masisi philhealth kung ayaw irefund mga private hospitals, daming over charging.

Or the other way around, they overcharge to cover for the unpaid philheath charges.

[dr. d]

The policy aims to deter those who are doing fraudulent / unethical acts. There will be a due process, hindi naman daw arbitrary.

If meron lang red flags observed then temporarily payment will stop and a deeper validation and checking doon sa mga submitted claim nung identified facility / professional.

In a way this is done to safeguard the public fund para mas sustainable yung program.


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i read somewhere before,
kahit "suspicion" lang daw,
suspend na.
i hope i was mis-informed.

[cast_no_shadow]

i read somewhere before,
kahit "suspicion" lang daw,
suspend na.
i hope i was mis-informed.

Have you read the issued Circular doc?

Yes, temporarily suspend payments. If cleared then it will be paid eventually.

Meron at meron naman talaga salbahe na facility / professionals.

For sure meron na sila shortlist niyan mga madalas mareklamo and may red flags based sa monitoring / post audit reports.


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[baludoy]

I think the term is 'nagkukumahog'. Naririnig ko yan sa nanay ko eh. San sila sa Japan? Di ko pa nakamusta ulit yung mga relatives namin sa Nagoya,

iyon pala iyong tamang term na iyon

sa chiba sila. shutdown tuloy operations nung kompanya for 2 weeks.

[shadow]

The policy aims to deter those who are doing fraudulent / unethical acts. There will be a due process, hindi naman daw arbitrary.

If meron lang red flags observed then temporarily payment will stop and a deeper validation and checking doon sa mga submitted claim nung identified facility / professional.

In a way this is done to safeguard the public fund para mas sustainable yung program.


Sent from my iPhone using Tapatalk

Problema buong batch yata ang stop payment hinde lang yun individual na suspected case so damay lahat.


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[dr. d]

Have you read the issued Circular doc?

Yes, temporarily suspend payments. If cleared then it will be paid eventually.

Meron at meron naman talaga salbahe na facility / professionals.

For sure meron na sila shortlist niyan mga madalas mareklamo and may red flags based sa monitoring / post audit reports.


Sent from my iPhone using Tapatalk

it's all over the hospital viber groups, po.

this is my understanding.
the philhealth vice president shall send a "notice of findings" to the healthcare professional (HCP) via available communication, including email, texting, private courier or professional service.
HCP is required to answer and present his answer or explanation, to philhealth, within three calendar (not working!) days of receipt of notice.
if his answer is found "lacking merit" or if no answer is sent back by the HCP within the prescribed period,
the recommendation to suspend payment to the HCP is forwarded to the President and CEO.
if the president and ceo does not act on it within 30 days, the recommendation to suspend shall be deemed approved.
suspension is for a maximum of 120 days, with option to extend an additional 90 days.
bottomline, philhealth can suspend payment to the doctor for up to 7 months, "on suspicion".

the philhealth president and ceo is not a doctor. he is a CPA-lawyer.
i am assuming he has physicians to help him understand the medical nuances of the investigation.

when presented for comment,
a number of our physicians were very upset over the circular, for reasons i do not completely comprehend.

a few years ago,
philhealth claimed some of the health facilities were making false claims.
an example, is the dialysis center.
philhealth claimed that the dialysis center was making false claims, that it was claiming for dialysis on deceased patients.
i asked a colleague about this.
ang sabi niya,
"sometimes, the dialysis clinic makes ipon the claims documents. by the time they send the documents, the patient had just died."

sometimes, there is a reasonable explanation behind suspicious suspicions...

but in my opinion,
this philhealth-healthcare worker friction stems from one thing: they do not trust each other.

i do have one query,
if the suspect HCP is the hospital and suspended pending investigation, are the professional fees of all the physicians serving in that hospital, included in the suspension of payments?
conversely, if the HCP physician is suspended, how will this affect the rest of the hospital he is serving under?

[Sweetlucious]

Did you guys know na pati private nurse may bidding war among patients.

My covid positive cousin got 3 nurses everyday, then suddenly on third day yun 3 di na nagpakita. When a doctor inquired about the nurses, sabi ng cousin ko baka absent lang, asked ng doctor “tatlo sabay sabay absent? Nasa iba na yan!”

[uls]

pfizer vaccine gets full US FDA approval

graduate na from EUA

[misseksaherada]

Wew!! eye-opening ito Doc D.
Ang dating sakin, sobrang bulok ang IT System ng Philhealth.. Parang walang centralized system.. Saklap naman nyan 30 days up to 7 months para sa case na "under suspicion".. Hassle siguro mag-claim kaya iniipon muna yung sa dialysis?
Yung old claim system siguro ng Philhealth manageable pa nun kaya di siguro nila ni-prioritize ayusin kasi gumagana naman (kahit mabagal).. Ngayong pandemic, sabog! Kaya hirap din sila sa audit.. Kahit matapos na pandemic, yung paper works nila siguro taon pa bago nila matapos..
For sure, bara-bara na trabaho na lang ulit matapos lang.. Magnet lalo sa corruption kasi nga walang record.. Tatamarin ka na lang mag-investigate.. Hanggang sa kalimutan na lang..
Mag-budots na lang.. [emoji28]
Kaysa mabuhay sa nakaraan, mag-move on na lang ang mga Pinoy..

it's all over the hospital viber groups, po.

this is my understanding.
the philhealth vice president shall send a "notice of findings" to the healthcare professional (HCP) via available communication, including email, texting, private courier or professional service.
HCP is required to answer and present his answer or explanation, to philhealth, within three calendar (not working!) days of receipt of notice.
if his answer is found "lacking merit" or if no answer is sent back by the HCP within the prescribed period,
the recommendation to suspend payment to the HCP is forwarded to the President and CEO.
if the president and ceo does not act on it within 30 days, the recommendation to suspend shall be deemed approved.
suspension is for a maximum of 120 days, with option to extend an additional 90 days.
bottomline, philhealth can suspend payment to the doctor for up to 7 months, "on suspicion".

the philhealth president and ceo is not a doctor. he is a CPA-lawyer.
i am assuming he has physicians to help him understand the medical nuances of the investigation.

when presented for comment,
a number of our physicians were very upset over the circular, for reasons i do not completely comprehend.

a few years ago,
philhealth claimed some of the health facilities were making false claims.
an example, is the dialysis center.
philhealth claimed that the dialysis center was making false claims, that it was claiming for dialysis on deceased patients.
i asked a colleague about this.
ang sabi niya,
"sometimes, the dialysis clinic makes ipon the claims documents. by the time they send the documents, the patient had just died."

sometimes, there is a reasonable explanation behind suspicious suspicions...

but in my opinion,
this philhealth-healthcare worker friction stems from one thing: they do not trust each other.

i do have one query,
if the suspect HCP is the hospital and suspended pending investigation, are the professional fees of all the physicians serving in that hospital, included in the suspension of payments?
conversely, if the HCP physician is suspended, how will this affect the rest of the hospital he is serving under?

[BratPAQ]

Wew!! eye-opening ito Doc D.
Ang dating sakin, sobrang bulok ang IT System ng Philhealth.. Parang walang centralized system.. Saklap naman nyan 30 days up to 7 months para sa case na "under suspicion".. Hassle siguro mag-claim kaya iniipon muna yung sa dialysis?
Yung old claim system siguro ng Philhealth manageable pa nun kaya di siguro nila ni-prioritize ayusin kasi gumagana naman (kahit mabagal).. Ngayong pandemic, sabog! Kaya hirap din sila sa audit.. Kahit matapos na pandemic, yung paper works nila siguro taon pa bago nila matapos..
For sure, bara-bara na trabaho na lang ulit matapos lang.. Magnet lalo sa corruption kasi nga walang record.. Tatamarin ka na lang mag-investigate.. Hanggang sa kalimutan na lang..
Mag-budots na lang.. [emoji28]
Kaysa mabuhay sa nakaraan, mag-move on na lang ang mga Pinoy..

For me it's more than IT system. Heard from few years ago na may racket na mga clinic para maka claim sa Philhealth. Maghahanap ng tao na babayaran ng 1k para magpa cataract surgery. Then the clinic will claim it sa Philhealth. More than the systems, they need to think of way to handle these scams better without impending those legit claims.

Its either mag higpit ka at nahirapan lahat mag claim or luwagan mo at ubos pondo mo sa mga kurakot.

[dr. d]

Did you guys know na pati private nurse may bidding war among patients.

My covid positive cousin got 3 nurses everyday, then suddenly on third day yun 3 di na nagpakita. When a doctor inquired about the nurses, sabi ng cousin ko baka absent lang, asked ng doctor “tatlo sabay sabay absent? Nasa iba na yan!”

i did not know.
but i wouldn't be surprised.

skilled worker piracy is a tail as old as time.
it happens in high-end corporations.
it happens in the entertainment industry.
it happens in specialized industries.
it even happens in the casa service industry! kinuwento ng colleague ko, "dr. d, my favorite mekanikos in the casa have all dis-appeared! they were pirated by a saudi car dealer!"

[Yatta]

Smells fishy.

Further, the governor reportedly told operators that they could buy the devices through a supplier in Cebu, though its price was higher compared to online shops.

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[Sweetlucious]

i did not know.
but i wouldn't be surprised.

skilled worker piracy is a tail as old as time.
it happens in high-end corporations.
it happens in the entertainment industry.
it happens in specialized industries.
it even happens in the casa service industry! kinuwento ng colleague ko, "dr. d, my favorite mekanikos in the casa have all dis-appeared! they were pirated by a saudi car dealer!"

But it’s unethical doc., and it adds to the burden of the patients.

Kaya ang laki ng gastos ng covid patients, you need around 4-5 doctors, meds that cost 10k above kasi most are intravenous, private nurse 2 or 3, depende sa hours if its 8hrs or 12hrs), then the ppe of the nurses that you could buy outside the hospital for around 300/set but hospitals wanted na sakanila dapat bilhin and they charge 1,5k/set. So 3 nurses 4,5 kaagad yun.