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    Philippine Health Insurance Corp Vs Chinese General Hospital and Medical Center

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    wesleybooks
    Chinese General Hospital (CGH) filed Medicare claims totaling 14 million pesos with Philippine Health Insurance Corporation (Philhealth) beyond the 60-day deadline. Philhealth denied the claims due to this late filing. The Supreme Court ruled in favor of CGH, finding that the 60-day rule is unreasonable given the documentation requirements and that patients' inability to immediately file documents. Strict enforcement of technical rules would defeat the goal of providing healthcare to members. The underlying law does not specify a deadline, and technicalities should not prevent realizing the state's healthcare policy.

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    Philippine Health Insurance Corp Vs Chinese General Hospital and Medical Center

    Uploaded by

    wesleybooks
    904 views1 page
    Chinese General Hospital (CGH) filed Medicare claims totaling 14 million pesos with Philippine Health Insurance Corporation (Philhealth) beyond the 60-day deadline. Philhealth denied the claims due to this late filing. The Supreme Court ruled in favor of CGH, finding that the 60-day rule is unreasonable given the documentation requirements and that patients' inability to immediately file documents. Strict enforcement of technical rules would defeat the goal of providing healthcare to members. The underlying law does not specify a deadline, and technicalities should not prevent realizing the state's healthcare policy.

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    Philippine Health Insurance Corp vs Chinese General Hospital and Medical Center

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    Chinese General Hospital (CGH) filed Medicare claims totaling 14 million pesos with Philippine Health Insurance Corporation (Philhealth) beyond the 60-day deadline. Philhealth denied the claims due to this late filing. The Supreme Court ruled in favor of CGH, finding that the 60-day rule is unreasonable given the documentation requirements and that patients' inability to immediately file documents. Strict enforcement of technical rules would defeat the goal of providing healthcare to members. The underlying law does not specify a deadline, and technicalities should not prevent realizing the state's healthcare policy.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    904 views1 page

    Philippine Health Insurance Corp Vs Chinese General Hospital and Medical Center

    Uploaded by

    wesleybooks
    Chinese General Hospital (CGH) filed Medicare claims totaling 14 million pesos with Philippine Health Insurance Corporation (Philhealth) beyond the 60-day deadline. Philhealth denied the claims due to this late filing. The Supreme Court ruled in favor of CGH, finding that the 60-day rule is unreasonable given the documentation requirements and that patients' inability to immediately file documents. Strict enforcement of technical rules would defeat the goal of providing healthcare to members. The underlying law does not specify a deadline, and technicalities should not prevent realizing the state's healthcare policy.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Philippine Health Insurance Corp vs Chinese General Hospital and Medical Center

    GR 163123

    Facts:
    CGH (Chinese General Hospital) filed its Medicare claims with Philhealth (amounting to 14M). However,
    Philhealth denied the claims because they were filed beyond 60 days after the discharge of the patient.
    This is in accordance with the implementing rules and regulations of RA 7875, Section 52 of which
    provides:

    SECTION 52. Fee for Service Guidelines on Claims Payment. – xxx b. All claims for payment of services
    rendered shall be filed within sixty (60) calendar days from the date of discharge of the patient.
    Otherwise, the claim shall be barred from payment except if the delay in the filing of thee claim is due to
    natural calamities and other fortuitous events. If the claim is sent through mail, the date of the mailing
    as stamped by the post office of origin shall be considered as the date of the filing.

    Issue: WON CGH is entitled to received payment from Philhealth YES

    Held:
    Philhealth should reimburse CGH due to several factors:
    1. There are several requirements that need to be accomplished before a claim is filed with
    Philhealth, which often necessitate securing documents from other government offices;
    2. Most patients are unable to immediately accomplish, file and submit the required documents

    Under these circumstances, it is unreasonable to expect CGH to comply 100% of the time with the
    prescribed 60-day rule of Philhealth. Also, unreasonably strict implementation of the 60-day rule,
    without regard to the causes of delay beyond CGH’s control, will be counter-productive to the long-term
    effectiveness of the health program. The Court will not hesitate to allow a liberal implementation of the
    rules and regulations of an admin agency in cases where their rigid enforcement will result in a
    deprivation of legal rights.

    Also, RA 7875 shows that the law itself does not provide for any specific period within which to file
    claims. It was only the IRR which established the 60-day cut off for the filing of claims. Technicalities
    should not defeat the realization of the state policy to provide Philhealth members with medical care.

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