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.
