THE CATCH 22 CONUNDRUM OF ZERO BALANCE BILLING

THE CATCH 22 CONUNDRUM OF ZERO BALANCE BILLING

So far, about four cases of this Catch-22 situation have been reported to me by my readers. For them, it feels like being caught between the devil and the deep blue sea. On paper, Zero Balance Billing (ZBB)—also called No Balance Billing—sounds like a godsend. The announcement is simple and reassuring: if you are confined in certain public hospitals, you pay nothing. Zero. Walang babayaran.

But as with many well-intentioned government programs, the devil is in the details.

The first and most common “catch” is this: to qualify for ZBB, the patient must be admitted to a ward, not a private room. That sounds reasonable—until real life intrudes. In emergencies, patients do not shop around for beds. They are rushed in, sometimes unconscious, sometimes barely able to understand what is happening. If the ward is full—and anyone who has stepped into a public hospital knows how common this is—the patient ends up in a private room. Sometimes it is the doctor who orders it, sometimes it is the nurse who says, “Sir/Ma’am, wala na pong ward.” The patient or the family consents, not fully realizing that this single decision instantly disqualifies them from ZBB.

And once you are in a private room, the billing starts—everything is charged, indigent or not. The promise of “zero” evaporates.

This leads us to another Catch-22. The government allows public hospitals to maintain private rooms to augment their income. In theory, this helps hospitals survive. In practice, it has become a trap for the poor. Some patients report that they simply could not afford to wait for a ward bed, especially when the condition was life-threatening. They agreed to a private room to save a life, only to be punished later with crushing bills. Is that really a “choice”?

There is also the lesser-discussed but equally cruel Catch-22 involving medicines and supplies. Under ZBB rules, everything should be provided by the hospital. But what happens when the hospital pharmacy is out of stock—a common occurrence in many government facilities? The patient is told to buy the medicine outside. If they buy it, they have technically paid out of pocket, breaking the “zero balance” promise and often making reimbursement difficult, if not impossible. If they do not buy it, they strictly comply with ZBB—and risk their health, or even their life.

So the loop goes like this: you are entitled to free treatment, but only if the hospital has the medicine. If it does not, you must spend your own money, and the treatment is no longer “free.” That is the very definition of a Catch-22.

Another paradox involves “better care.” ZBB applies only to basic wards. Yet for some conditions—infectious diseases, post-surgery monitoring, or cases needing isolation—a private room may actually be medically advisable. The moment you move there, however, the benefit disappears. Universal access becomes conditional access.

Why has this not exploded into a full-blown public scandal? Perhaps because the middle class can still scrape together money—sell property, borrow heavily, max out credit cards. The poor, meanwhile, suffer quietly. But for me, this is a public issue that deserves daylight.

How do we end these Catch-22 situations? One obvious step is to allow ZBB eligibility to follow the patient, not the room, especially in emergencies or when ward beds are unavailable. Another is to fix the supply-chain problem. A “zero bill” policy is meaningless if hospitals have empty pharmacies. Clear, written consent—explaining the financial consequences—should also be mandatory before any transfer to a private room.

ZBB was meant to protect patients from financial ruin. It should not become a policy that says, “You are free—unless you actually need care.”

If you or someone you know has fallen victim to any of these Catch-22 situations, let me know. Silence only allows the paradox to continue.

RAMON IKE V. SENERES

www.facebook.com/ike.seneres iseneres@yahoo.com senseneres.blogspot.com 09088877282/03-19-2027