How My Fish Farm Overseer's Niece Gave Birth for Free!

How My Fish Farm Overseer’s Niece Gave Birth for Free!

My fish farm overseer has a niece. My daughter hired her as nanny in Quezon City, Philippines. Recently the niece, who is from Pangasinan, became a single mom. She got pregnant by her boyfriend, who works nearby. 

All of us were taken by surprise when we learned she was pregnant. My daughter learned about it less than 2 months before the nanny gave birth. The niece had always said she was just fat and just got fatter. She hardly took time off from work.

Quite recently my daughter learned, through the doctor, that her nanny will give birth third week of May. So we planned to drive her home to Santa Barbara, Pangasinan where she can be with her parents when her time comes.

But then it turned out she was due much earlier than that. Yesterday, April 28, the nanny gave birth to a baby boy. Good thing my daughter already had plans to take her to a lying-in clinic. The clinic hesitated (because the nanny's baby may be premature), and instead referred her to a nearby government medical center for check-up.
 
The nanny was taken to the Quirino Memorial Medical Center (QMMC), a government hospital, in Quezon City, where she was admitted. A couple of hours later, the doctors helped deliver her baby boy.

Niece’s Background

Elsa is 19 years old whose poor parents in Sta. Barbara, Pangasinan work as farmers. She has 6 siblings.

Since my daughter hired her, Elsa had been a great help to her parents financially. She sent them money regularly. She worked as nanny for my daughter’s 11 month-old daughter.

Being unmarried and below 21 years old, Elsa is supposed to have health insurance coverage as dependent of her mom, who Elsa knew is a Philhealth member. Her mom is also a beneficiary of the Philippine Government’s 4Ps (a poverty alleviation program). Under this program, the government gives cash to the poor. In exchange, the poor parents keep their young children longer in school and send them to health centers for regular check-up. 

All 4Ps beneficiaries are automatically covered by Philhealth.

When Elsa got pregnant, her world turned upside down. My daughter will lose a trusty nanny. Elsa will lose her job because she’ll have her baby to take care of. Elsa’s parents in Pangasinan will lose the regular cash remittances sent in by their daughter. She’ll also face uncertainty once she delivers her baby. How much does it cost to deliver her unborn child, where will she go, who will attend to her, how will her family take the news?

How Government Helps the Poor

Fortunately all was not lost for Elsa during her crisis. With my daughter to help out, she was admitted to a government hospital (QMMC) which took in Elsa without any fuss. And after a few hours in labor, she delivered her baby boy.

Most importantly, Elsa didn’t have to pay a single peso for the hospital charges and doctor’s fees for herself and her newborn. I myself knew this because I personally worked out all documents and paper work.

Hospital charges and doctor's fees for the infant; actual charges less amount absorbed by Philhealth is a net payable; this amount was waived by the hospital and patient was discharged for free

Hospital charges and doctor's fees for the mother; actual charges less amount absorbed by Philhealth is a net payable; this amount was waived by the hospital and the mother discharged for free

All costs were borne by the government courtesy of the Philippine Health Insurance Corporation (Philhealth). It's a government-owned, controlled corporation set up to provide universal health coverage for Filipinos. 

When we brought Elsa’s case to the Philhealth desk at the QMMC’s Admitting Section, the attending staff learned that she’s only 19 and single. But they can’t find her mother’s member data record, as principal member, in their Philhealth online systems. 

Normally this would have caused major problems for Elsa. She has no Philhealth coverage. Her mom, who she knows has one, for some reason, can't be located in the Philhealth system. So she can’t rely on her mom too.

Fortunately, the QMMC’s Social Welfare Office enrolled Elsa as a hospital-sponsored member. The Office gave her a one-time free health insurance coverage, through Philhealth, up to December 31, 2016. Which means she got entitled to free hospitalization, for herself and her newborn. The only condition: Elsa commits to pay the annual insurance premium of Php2,400 for 2017 and beyond.
 
To work out the free hospitalization for Elsa and her newborn, we had to patiently comply with QMMC’s document requirements, fill out all the needed forms, and go to various offices in QMMC.

Documents

I assume that the documents and procedures below are common among government hospitals. I may have missed some but these are what I recall doing after one full day’s work, assisted by my fish farm overseer, Elsa's aunt.

1. Patient Slip (PS) – Upon arrival at the hospital, the mom who is due to deliver her child is brought to the Admitting Section (AS). The AS staff gives the patient a Patient Slip. The patient (or companion) then writes her complete name, address, birth date, name of parents, contact number. This is the basis for filling out the ADR below.

2. Admission and Discharge Record (ADR) – a form issued by the Admitting Section based on the patient information written in the PS.

3. Patient’s Rights and Obligations

4. QMMC (Hospital) Rules and Regulations - The rules cover visiting hours, dress code for visitors, food, bringing personal effects, cleanliness, correct use of facilities, security peace and order, attending to hospital bills, discharge of patient.

5. Temporary Certificate of Live Birth – to be filled out in two copies in black ball pen by spouse, parent or guardian. This form has 3 parts:

(a) child information – name, sex, date of birth, place of birth, type of birth, birth order, weight at birth

(b) mother information – maiden name, citizenship, religion, number of children born alive, children still living including new born, occupation, age, residence

(c) father information – name, citizenship, religion, occupation, age at time of birth. Note: In Elsa's case this was left blank, the infant was named using her surname.

(d) other information such as date and place of marriage of parents, if applicable, attendant (physician, nurse, midwife, traditional midwife (hilot), others), and certification of birth by attending obstetrician as to time, with signature

Notes:

(a) if parents are married, they need to submit their Marriage Contract to the hospital’s Records Management Office (RMO) within 7 days from birth of newborn.

(b) if parents are not married, father should acknowledge his child within 7 days from the child’s birth date by submitting the Affidavit of Acknowledgment and the original and photocopy of both parent’s individual Community Tax Certificates to the RMO.

(c) Hospitals are required to register the Certificate of Live Birth before the 30th day and that if the child was not acknowledged by the father, the child will use the surname of the mother. Note: this is what we did.

This form needs to be signed by the infant's mother or father. The parent (s) confirm correctness of the information written on the temporary birth certificate. That they agree that the hospital will not be liable for any typo error or omission of details not recorded on this form.

6. Philhealth Member Registration Form (PMRF) (for patient herself who is a Philhealth member, or patient’s parent who is a member)

7. Philhealth Member Registration Form (PMRF) (for filling out basic personal info on mother and baby) – given to a qualified mother who is not yet a Philhealth member but is given a one-time free Philhealth insurance coverage until end of the year so that her hospitalization costs are absorbed by Philhealth. Note: Elsa falls under this category.

Note: Above PMRF form has 3 parts: (a) member information (b) declaration of dependents (c) membership category

8. Philhealth Claim Form 2 – consists of 4 parts: (a) health care institution information, (b) patient confinement information, (c) certification of consumption of benefits and consent to access patient records (d) certification of health care institution

This form is to be filled out by the attending doctor/nursing station indicating among others (a) admission diagnosis (b) discharge diagnosis (c) type of applicable package (like newborn care package) and the list of care procedures, tests, vaccinations administered

Essential Newborn Care

· Immediate drying of newborn

· Early skin-to-skin contact

· Timely cord clamping

· Eye prophylaxis

· Weighing of newborn

· Vitamin K administration

· BCG vaccination

· Hepatitis B vaccination

· Non-separation of mother/baby for early breastfeeding initiation


Note: It was  reassuring to know that the above newborn care procedures (which I learned are up to current standards) were done for free for Elsa's baby or for any other newborns.

Newborn Hearing Screening Test

Newborn Screening Test
 
Note: above tests are applicable to maternity/childbirth cases and were done for Elsa's infant.

Patient, member, or authorized representative is required to sign under “Consent to Access Patient Records”.

9. Certificate of Live Birth (CLB) – this form is issued by the Nursing Station to the spouse, parent or guardian of the new mother. It’s a form for the Office of the Civil Registrar of the city or municipality where the infant was born. It’s to be accomplished in quadruplicate. The procedure is to take the 4 blank CLB forms together with the Temporary CLB to the Records Management Office which will type in the required information on the CLB.

Like the Temporary CLB, the CLB has 3 parts: child information, mother information, father information

Once the CLB is fully accomplished and typed, it will be photocopied and a certified true copy is given to the patient upon her discharge. The registered CLB itself will be available to the mother/father after 5 weeks from date of birth of the child.

10. "Alagang Pinoy Tagubilin" – this is a form filled out by the Nursing Station and given to the mother prior to discharge. It indicates the appointment date and time for the post-delivery check-up of the mother.

11. NICU Discharge Instruction – this is a form also filled out by the Nursing Station and given to the mother before her discharge. It indicates the appointment date and time for the post-delivery check-up of the baby.

This form also shows date of birth, time of birth, type of delivery, antropometric measurements at birth such as head circumference (HC), chest circumference (CC), abdominal circumference (AC), length (L) or newborn height (NH), and weight (W), final diagnosis, date and type of vaccinations given at birth (like Hepa B vaccine and BCG vaccine), date of newborn screening test given.

12. Patient’s Statement of Account (for mother) – this form is prepared by the Billing Clerk at Administration Office and certified correct by an Administration Officer. 

It shows name of patient, health record number, address of patient, date of admission, time of admission, number of days confinement, age of patient, the details of hospital charges, due from Philhealth and net amount payable, also the professional fees (showing name of physician, actual charges, due from Philhealth, and net amount due).

13. Patient’s Statement of Account (for newborn) – this form is also prepared by the Billing Clerk at Administration Office and certified correct by an Administration Officer. 

It shows name of newborn, health record number, Philhealth number of mother, confinement period, details of hospital charges, amount absorbed by Philhealth, the net amount payable, also the professional fees less amount shouldered by Philhealth and net amount payable, if any.

14. Barangay Clearance – issued by the Barangay where mother is a resident and shows name, address, date of birth, place of birth, purpose for issuance (for Philhealth), remarks (such as no derogatory record), clearance number, validity. The Barangay Clearance is approved by the Barangay Head. This is a required document at the Admitting Office and serves as identification, in absence of IDs or birth certificate.

15. Philhealth CARES Verificaton Slip – CARES stands for Customer Relations, Assistance and Empowerment Staff. She is a registered nurse under the employ of Philhealth deployed to accredited level 3 and 4 hospitals to provide customer assistance to Philhealth members. The CARES staff helps the members avail of their benefits outright.

At the QMMC, the CARES has a dedicated Philhealth desk at the Admitting Section and is just beside the Social Welfare Office. 


The staff answers questions about Philhealth. She explains Philhealth policies and rules, benefits, membership procedures, and other information that members may need. She talks to the patient’s spouse, parent or guardian on the patient's background, categorizes the patient, and gives instructions on how Philhealth benefits can be applied.

The CARES staff logs on to the Philhealth online systems to verify member data record and to establish member eligibility.

The Philhealth CARES Verification Slip is a form prepared by the CARES staff after verifying the member data record and eligibility using the Philhealth online systems. The staff also indicates the membership category of the patient (sponsored member, OFW, etc.) after her interview on the patient's background.

The staff gives the  completed Verification Slip to the spouse, parent or guardian for submission to the Social Welfare Office for processing.

16. Philhealth Point of Care Certification (PPCC) – This is a certification form filled out by the Social Welfare Office based on the CARES Verification Slip issued by the Philhealth CARES desk.

The PPCC shows the name of patient, date of birth, address, and date the patient is enrolled as a hospital sponsored member. It’s prepared by a social welfare officer and approved by the Head of the Medical Social Service.

The PPCC shows that the patient is eligible to become a sponsored member. By being a sponsored member, she will have insurance coverage until end of the year (validity date).

Note that a sponsored member is someone whose Philhealth insurance contribution is paid by another entity (such as a government hospital). This privilege is given only to qualified patients such as:

· Those coming from the informal sector in the low-income bracket

· Orphans, abandoned children, abused minors, out-of-school youth, street children, persons with disability, senior citizens, and battered women

· Barangay health workers, nutrition scholars, barangay tanods, and other barangay workers and volunteers

· Unenrolled women who are about to give birth, if such women are indigent as determined by CARES.

Elsa, my daughter’s nanny and my fish farm oversee's niece, who is single, pregnant, and whose family is indigent, falls under the last category.

17. Patient’s Identification Card – issued to a discharged patient showing the health record number and name of patient. It will be presented to the Outpatient Department when the patient comes back for check-up.

18. Medicine Slip – Issued to the patient showing the amount of medicine allowance granted (such as Php1,000). The Medicine Slip is taken to the Pharmacy together with the original copy of doctor’s prescription. The Pharmacy fills out the cost of medicines actually given to the patient. All subsequent issues of medicines are costed and entered in the Medicine Slip until the allowance is fully used up. 

My daughter's nanny received a medicine allowance of P1,000 and got her prescribed medicines for free.

After Elsa gave birth, we took her to our house in Quezon City where she and baby recuperated for two days. On May 2, we drove her and her newborn to Elsa's parents at Sta. Barbara, Pangasinan.

Note: Recently, we were informed that the boyfriend made good his promise to support Elsa and her newborn. He has been sending financial support since Elsa gave birth.

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