MISCOMMUNICATIONS IN ZERO BALANCE BILLINGS
MISCOMMUNICATIONS IN ZERO BALANCE BILLINGS
Zero Balance Billing (ZBB), also known as No Balance Billing (NBB), is one of those government policies that sound simple, generous, and humane: qualified patients pay zero pesos for their hospital bills. Under the Universal Health Care (UHC) Law and recent directives of the Marcos administration, its coverage has been expanded significantly. On paper, this is good news. On the ground, however, miscommunications continue to cause confusion, frustration, and unnecessary complaints.
Let me be clear at the outset: Zero Balance Billing is not automatic, and it does not apply everywhere. There are three non-negotiable conditions. First, the hospital must be government-run or a DOH-accredited public facility. Second, the patient must be admitted to a ward or basic accommodation. Third, the services must fall within the PhilHealth case rate package, meaning standard care, medicines available in the hospital pharmacy, laboratory tests, and professional fees.
Private hospitals? They are only required to allocate 10 percent of their beds for ZBB wards. Some offer special “Z-Benefit” packages for cancer, heart disease, and other serious conditions, but these require prior coordination with PhilHealth. This is where expectations and reality often collide.
So far, I have personally received two complaints from patients who believed they were denied their Zero Balance Billing benefits. After checking the facts, both turned out to be classic cases of miscommunication rather than outright denial.
In the first case, the attending physician admitted the patient to a private room because no charity ward bed was available at the time. The patient assumed ZBB would still apply. Unfortunately, rules are rules. Once you are placed in a private room—regardless of who made the decision—you automatically forfeit Zero Balance Billing.
In the second case, the situation was more urgent. The patient needed immediate surgery, and again, no ward bed was available. The doctor chose a private room to save time. Medically justified, yes. Financially protected under ZBB? No.
That is why I am not blaming anyone here—not the doctors, not the hospitals, not the patients, and not even the government. The real problem lies deeper.
Public hospitals were allowed to open private rooms primarily to generate additional income and augment their chronically insufficient budgets. That decision may have been practical, but it created an unintended side effect: indigent patients are sometimes forced into private rooms due to bed shortages, thereby losing benefits meant to protect them.
This brings us to the real question: Why are public hospitals still underfunded in a country that claims health care is a priority? If government hospitals had enough beds, enough staff, and enough operating funds, there would be no need to push patients into private accommodations in the first place.
The long-term solution is obvious: increase public hospital budgets so they are not compelled to rely on private rooms for survival. In the short term, policies can still be adjusted. Why not allow ZBB to apply when a patient is involuntarily placed in a private room due to lack of ward availability? Why should the poorest patients pay for system failures they did not create?
Finally, a practical reminder: if you are in a DOH hospital and are being asked to pay, do not panic and do not argue at the billing window. Look for the PhilHealth CARES desk or the Medical Social Services office. Their job is to ensure that Zero Balance Billing is properly applied before you are discharged.
Zero Balance Billing is a powerful social protection tool. But unless we fix the communication gaps—and the budget gaps—it will remain a policy that looks better in press releases than in hospital corridors.
RAMON IKE V. SENERES
Comments
Post a Comment