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Denied Claims of Patients Admitted at Dr. Luis Malaluan Hospital

1. Dr. Philbert Malaluan filed a motion for reconsideration of denied claims from Dr. Luis Malaluan Hospital. The claims, totaling over P150,000, were denied by PhilHealth Region XII for being filed beyond the 60-day statutory period. 2. Dr. Malaluan argues that the claims were actually mailed on the 60th day, as evidenced by the attached LBC receipt, and that under the rules, the mailing date should be considered the filing date. 3. In the motion, Dr. Malaluan requests that the claims be reconsidered, processed, and paid according to government rules and regulations.

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131 views

Denied Claims of Patients Admitted at Dr. Luis Malaluan Hospital

1. Dr. Philbert Malaluan filed a motion for reconsideration of denied claims from Dr. Luis Malaluan Hospital. The claims, totaling over P150,000, were denied by PhilHealth Region XII for being filed beyond the 60-day statutory period. 2. Dr. Malaluan argues that the claims were actually mailed on the 60th day, as evidenced by the attached LBC receipt, and that under the rules, the mailing date should be considered the filing date. 3. In the motion, Dr. Malaluan requests that the claims be reconsidered, processed, and paid according to government rules and regulations.

Uploaded by

Evan Larona
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Philippine Health Insurance Corporation


PhilHealth Regional Office XII
Koronadal City
RE:

ADMINISTRATIVE PROTEST ON
DENIED CLAIMS OF PATIENTS
ADMITTED AT DR. LUIS MALALUAN
HOSPITAL;

DR. PHILBERT G. MALALUAN,


Medical Director,
Dr. Luis Malaluan Hospital,
Poblacion, Kidapawan City
X-----------------------------------------X

MOTION FOR RECONSIDERATION


The undersigned movant, unto this Honorable Office, most respectfully files this
Motion for Reconsideration and states that:
1. The following claims were denied by PhilHealth Region XII on the grounds that
said claims were FILED BEYOND 60 DAYS STATUTORY PERIOD, to wit:

CLAIM #

DATE
ADDMITTED
AND
DISCHARGED

ICD
CODE

AMOUNT
CLAIMED

190007857334

1401271701050

11/14/2013
11/17/2013

L03.3,
R50.9

P4,768.55

RITA D.
VERDAD

230015314791

1401301701723

11/05/2013
11/09/2013

N39.0,
K29.1,
E86.0

P5,200.00

WIDENE L.
PAULINO

230015316115

1401301701736

11//05/2013
11/09/2013

N39.0,
E86.1

P5,200.00

CHARLIE T.
OMANA

230015316018

1402191700925

12/10/2013
12/13/2013

A09,
E86.1

P6,000.00

WILSON A.
SUMBILON

172000053975

1402191700916

12/10/2013
12/13/2013

GLENDEL G.
PAUSAL

170501379010

1402191700656

12/02/2013
12/06/2013

JIMBERLY A.
LARGO

172005894347

1402191700655

12/02/2013
12/06/2013

ANNA BELLA
G.
DESCALZO

170252036108

1402051701806

11/17/2013
11/21/2013

MELANIE S.
MACLA

230015895778

1402201700073

12/02/2013
12/12/2013

AO9,
E86.1

P6,000.00

10

MARILYN R.
RAMOS

170000709045

1402201700075

12/08/2013
12/12/2013

J18.92

P15,000.0
0

Name of Patient

PHILHEALTH
ID #

ARIES B.
CIPRIANO

I10.90
,
R56.0
N39.0,
K29.1,
E86.1
N39.0,
K29.1,
E86.1
N39.0,
K29.1,
E86.1

P9,000.00
P5,200.00
P5,200.00
P5,200.00

REASON
FOR RTH
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS

CLAIM #

DATE
ADDMITTED
AND
DISCHARGED

ICD
CODE

AMOUNT
CLAIMED

230015331548

1402201700077

12/09/2013
12/12/2013

J18.92

P15,000.0
0

JOAN
DEVER P.
CAMPOID

230015896375

1402201700081

12/08/2013
12/12/2013

13

HELEN M.
BALUYOT

230015320589

140220170070

12/08/2013
12/12/2013

14

JESSA MAE
O. OMBAT

230015321070

1402101701759

12/04/2013
12/06/2013

J45.90

P9,000.00

15

LAYLAY I.
MANAGTAL

230015895506

1402101701752

12/04/2013
12/06/2013

J18.92

P15,000.0
0

16

KAYANGGAN
T. BAYAWAN

172004804320

1402101701749

12/04/2013
12/06/2013

J18.92

P15,000.0
0

17

CLARITA D.
CASPE

170500532508

1402101701748

12/03/2013
12/06/2013

I10.90
, N10

P9,000.00

18

MERCY
GRACE C.
CANDADO

172012325628

1402281700042

12/17/2013
12/20/2013

AO9,
E86.1

P6,000.00

19

ARA M.
ANDO

230015895344

1402281700041

12/17/2013
12/20/2013

J45.90

P9,000.00

20

ERNESTO G.
SIANGCO

172012040291

1402281700040

12/17/2013
12/20/2013

I10.90

P9,000.00

21

RENE R.
ANARNA

172012252329

1402281700044

12/17/2013
12/20/2013

AO9.0
,
E86.1

P6,000.00

22

EFREN I.
LLANTO

230015896731

1402281700048

12/17/2013
12/20/2013

A01.0,
E86.1

P14,000.0
0

172001853118

1402281700039

12/17/2013
12/20/2013

J18.92

P15,000.0
0

172009698376

1402281701143

12/17/2013
12/20/2013

170250085276

1402271701126

12/06/2013
12/082013

Name of Patient

PHILHEALTH
ID #

11

CHARLYN T.
ALQUIZAR

12

23

24

25

DELLY JOY
C.
ELOGSONG
LEAH MAE
C.
MANGUMPIT
JANE S.
CABILES

AO1.1
,
E86.1
AO1.1
,
E86.1

N39.0,
K29.1,
E86.1
T14.0,
S807,
S99.9

P14,000.0
0
P14,000.0
0

P4,900.00
P5,400.00

REASON
FOR RTH
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS
FILED
BEYOND
60 DAYS

2. Said claims were actually filed through mail (LBC) on the 60 th day from discharge
of said patients as indicated above, that is on ______________, as evidenced by
LBC Receipt No._____________ dated_____________, a copy of which is
attached herein and marked as ANNEX A of this Motion for Reconsideration.
3. As far as the herein movant is concerned, the rule in cases like these is: the date
of mailing is the date of filing. Hence, the movant believes that the above
mentioned claims should be considered as filed within the 60 days statutory
period for the filing of claims, and thus, should not have been denied;

WHEREFOR, premises considered, it is respectfully prayed that the


aforementioned claims be reconsidered, processed and accordingly paid, subject to
government rules and regulations.
April 28, 2014, Kidapawan City, Cotabato.

DR. PHILBERT G. MALALUAN


Movant

REPUBLIC OF THE PHILIPPINES)


PROVINCE OF SOUTH COTABATO )S.S.
CITY OF KORONADAL
)

VERIFICATION cum
AFFIDAVIT OF NON FORUM SHOPPING
I, PHILBERT G.MALALUAN, after being duly sworn to an oath,
depose and state, THAT:
1. I am the MOVANT in the above-entitled Motion for
Reconsideration;
2. I

have caused the preparation of the foregoing Motion;

3. I have read the contents thereof to the best of my


knowledge and belief and the same is true and correct.
4. I further certify that:
a. I have not heretofore commenced any action or filed
any claim involving the same issues in any court,
tribunal or quasi-judicial agency;
b. To the best of my knowledge, no other action or
claim is pending before any court, tribunal or
quasi-judicial agency;
c. If there is such other pending action or claim, I
shall state herein the complete statement of the
present status thereof; and if I should thereafter
learn that the same or similar action or claim has
been filed or is pending, I shall report that fact
within five (5) days therefrom to the court,
tribunal or quasi-judicial agency wherein the
aforesaid Petition has been filed.
IN WITNESS WHEREOF, I hereby affixed my signature, this
February 2, 2014, at Koronadal City, South Cotabato, Philippines.
PHILBERT G. MALALUAN

CTC No.______________
on ____________, 2014
at Kidapawan City

SUBSCRIBED AND SWORN to before me this _____________ at


Koronadal City, South Cotabato, Philippines.

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