PHILIPPINE HEALTH INSURANCE CORPORATION, petitioner, vs. CHINESE
GENERAL HOSPITAL AND MEDICAL CENTER, respondent. [G.R. No. 16313. A!"i# 1$, %%$& 'ACTS: On February 14, 1995, Republic Act No. 7875, otherwise known as An Act !nstitutin" a National #ealth !nsurance $ro"ra% &or all Filipinos an' (stablishin" the $hilippine #ealth !nsurance )orporation For the $urpose,* was appro+e' an' si"ne' into law. $rior to the enact%ent o& R.A. 7875. )hinese ,eneral #ospital -),#. ha' been an accre'ite' health care pro+i'er un'er the $hilippine /e'ical )are )o%%ission -$/))., %ore popularly known as /e'icare. !ts application &or the pay%ent o& its clai% with the 000 was o+ertaken by the passa"e o& R.A. 7875, which in 0ection 51 an' 51, pro+i'es2 SECTION 51. Merger. Within sixty (60) days fr! the "r!#$gatin f the i!"$e!enting r#$es and reg#$atins% a$$ f#n&tins and assets f the 'hi$i""ine Medi&a$ Care C!!issin sha$$ (e !erged )ith thse f the Cr"ratin ('*I+*E,+T*) )ith#t need f &n-eyan&e% transfer r assign!ent. The 'MCC sha$$ thereafter &ease t exist. The $ia(i$ities f the 'MCC sha$$ (e treated in a&&rdan&e )ith existing $a)s and "ertinent r#$es and reg#$atins. xxx SECTION 5.. Transfer f *ea$th Ins#ran&e /#nds f the SSS and 0SIS. The *ea$th Ins#ran&e /#nds (eing ad!inistered (y the SSS and 0SIS sha$$ (e transferred t the Cr"ratin )ithin sixty (60) days fr! the "r!#$gatin f the i!"$e!enting r#$es and reg#$atins. The SSS and 0SIS sha$$% h)e-er% &ntin#e t "erfr! Medi&are f#n&tins #nder &ntra&t )ith the Cr"ratin #nti$ s#&h ti!e that s#&h f#n&tins are ass#!ed (y the Cr"ratin xxx. For bein" alle"e'ly &ile' beyon' the si3ty -45. 'ay perio' allowe' by the i%ple%entin" rules an' re"ulations, 0ection 51 thereo&, petitioner6s clai%s were 'enie' by the )lai%s Re+iew 7nit o& $hilhealth in its letter 'ate' 8anuary 14, 155, thus2 1This "ertains t y#r three h#ndred se-enty three 'hi$hea$th !edi&are &$ai!s (232) )hi&h )ere "ri!ari$y denied (y C$ai!s 'r&essing 4e"art!ent fr $ate fi$ing and fr )hi&h y# !ade an a""ea$ t this ffi&e. We regret t infr! y# that after thr#gh e-a$#atin f y#r &$ai!s% 5y#r6 261 !edi&are &$ai!s )ere 4ENIE4% d#e t the fa&t that the &$ai!s )ere fi$ed 5 t 16 7 !nths after dis&harge. *)e-er% the re!aining !edi&are &$ai!s ha-e (een fr)arded t C$ai!s 'r&essing 4e"art!ent (C'4) fr "ay!ent. SECTION 5. (8) 9#$e 5. (8) 9#$e :III f the I!"$e!enting 9#$es and 9eg#$atins f 3;35 "r-ides that a$$ &$ai!s fr "ay!ent f ser-i&es rendered sha$$ (e fi$ed )ithin sixty (60) days fr! the day f dis&harge f the "atient. *)e-er% 'hi$hea$th Cir&#$ar N% 21<,% series f 1==;% state that a$$ &$ai!s "ending )ith 'hi$hea$th as f Se"te!(er 15% 1==; and &$ai!s )ith dis&harge dates fr! Se"te!(er t 4e&e!(er 21% 1==; are gi-en ne h#ndred t)enty (1.0) days fr! the date f dis&harge t fi$e their &$ai!. In as !#&h as )e )#$d $i>e t grant y#r re?#est fr re&nsideratin% the Cr"ratin &#$d n $nger extend the "erid f fi$ing xxx. ),# &ile' a petition &or re+iew un'er Rule 49 o& the Rules o& )ourt. :he )ourt o& Appeals or'ere' herein petitioner $hilippine #ealth !nsurance )orporation -$hilhealth. to pay the clai%s in the a%ount o& $14,191,548.71, principally on the "roun' o& liberal application o& the 45;'ay rule un'er 0ection 51 o& RA 78756s !%ple%entin" Rules an' Re"ulations. :hus, $hilhealth6s petition &or re+iew on certiorari. ISSUE: <hether or not $hilhealth is entitle' to recei+e pay%ent &ro% $hilhealth &or ser+ices ren'ere' &ro% 1989 to 1991. HELD: :he )ourt rule' that $hilhealth %ust pay the clai%s o& ),# an' a&&ir%e' the 'ecision o& the )ourt o& Appeals. A care&ul rea'in" o& RA 7875 shows that the law itsel& 'oes not pro+i'e &or any speci&ic perio' within which to &ile clai%s. <e can sa&ely presu%e there&ore that the perio' &or &ilin" was not per se the principal concern o& the le"islature. /ore i%portant than %ere technicalities is the reali=ation o& the state policy to pro+i'e $hilhealth %e%bers with the re>uisite %e'ical care at the least possible cost. :he &act is that it was not RA 7875 itsel& but 0ection 51 o& its !%ple%entin" Rules an' Re"ulations which establishe' the 45;'ay cut;o&& &or the &ilin" o& clai%s. <hile it is 'octrinal in a'%inistrati+e law that the rules an' re"ulations o& a'%inistrati+e bo'ies interpretin" the law they are entruste' to en&orce ha+e the &orce o& law?15@, these issuances are by no %eans iron;cla' nor%s. A'%inistrati+e bo'ies the%sel+es can an' ha+e in &act bent the rules* &or reasons o& public interest. On 0epte%ber 15, 1998, &or instance, petitioner issue' $hilhealth )ircular No. 91;A2?14@ :he unreasonably strict i%ple%entation o& the 45;'ay rule, without re"ar' to the causes o& 'elay beyon' respon'ent6s control, will be counter;pro'ucti+e to the lon";ter% e&&ecti+eness o& the N#!$. !nstea' o& placin" a pre%iu% on participation in the $ro"ra%, $hilhealth punishes an accre'ite' health pro+i'er like ),# by re&usin" to pay its clai%s &or ser+ices alrea'y ren'ere'. 7n'er these circu%stances, no accre'ite' pro+i'er will "a%ble on honorin" clai%s with 'elaye' supportin" papers A no %atter how %eritorious A knowin" that rei%burse%ent &ro% $hilhealth will not be &orthco%in".* :he a+owe' policy in the creation o& a national health pro"ra% is, as pro+i'e' in 0ection 11, Article B!!! o& the 1987 )onstitution, to a'opt an inte"rate' an' co%prehensi+e approach to health 'e+elop%ent which shall en'ea+or to %ake essential "oo's, health an' other social ser+ices a+ailable to all people at a&&or'able cost. !t is Our &ir%ly hel' +iew that the policy o& the state in creatin" a national health insurance pro"ra% woul' be better ser+e' by "rantin" the instant petition. * THIRD DIVISION [G.R. No. 163123. April 15, 2005] PHILIPPINE HEALTH INSURANCE CORPORATION, petitioner, vs. CHINESE GENERAL HOSPITAL AND EDICAL CENTER, respondent. D E C I S I O N CORONA, J.! Before us is a petition for review on certiorari under Rule 45 of the Rules of Court assailing the ar!h "#$ "%%4 de!ision &'( of the Court of )ppeals$ the dispositive portion of whi!h read* FOR THE FOREGOING DISQUISITIONS, the petition is GRANTED, the Philippine Health Insurance Corporation &"( is hereby ordered to give due course to petitioners, Chinese General Hospital and Medical Center, claims for the period from 199 to 199!, amounting to "#$%&''( MI))I#( &*# H$(+%'+ (I('&, #(' &H#$-.(+ "I/' H$(+%'+ -I0&, 'IGH& P'-#- and 112133 P'-#- 4P15,!91,6781198 &+( The fa!ts$ as !ulled ,- the Court of )ppeals$ follow. #n "ebruary 15, 1996, %epublic .ct (o8 116, other:ise ;no:n as <.n .ct Instituting a (ational Health Insurance Program for all "ilipinos and 'stablishing the Philippine Health Insurance Corporation "or the Purpose,= :as approved and signed into la:8 .s its guiding principle, it is provided in -ection ! thereof, thus> <-ection !8 +eclaration of Principles and Policies8 ? -ection 11, .rticle 0III of the Constitution of the %epublic of the Philippines declares that the state shall adopt an integrated and comprehensive approach to health development :hich shall endeavor to ma;e essential goods, health and other social services available to all the people at affordable cost8 Priority for the needs of the underprivileged, sic;, elderly, disabled, :omen, and children should be recogni@ed8 )i;e:ise, it shall be the policy of the -tate to provide free medical care to paupers8 Prior to the enactment of %8.8 1168 CGH &4( had been an accredited health care provider under the Philippine Medical Care Commission 4PMCC9, more popularly ;no:n as Medicare8 .s defined by %8.8 116, a health care provider refers to a health care institution, :hich is duly licensed and accredited devoted primarily to the maintenance and operation of facilities for health promotion, prevention, diagnosis, treatment and care of individuals suffering from illness, disease, inAury, disability or deformity, or in need of obstetrical or other medical and nursing care8 &5( .s such, petitioner &/( filed its Medicare claims :ith the -ocial -ecurity -ystem 4---9, :hich, together :ith the Government -ervice Insurance -ystem 4G-I-9, administered the Health Insurance "und of the PMMC8 &hus, petitioner filed its claim from 199 to 199! :ith the ---, amounting to 'IGH& MI))I#( #(' H$(+%'+ &*# &H#$-.(+ -'/'( H$(+%'+ 'IGH&,B&*# and 132133 4P,13!,1!81398 Its application for the payment of its claim :ith the --- :as overta;en by the passage of %8.8 116, :hich in -ection 61 and 6!, provides> -'C&I#( 618 Merger8 ? *ithin siCty 4739 days from the promulgation of the implementing rules and regulations, all functions and assets of the Philippine Medical Care Commission shall be merged :ith those of the Corporation 4PHI)H'.)&H9 :ithout need of conveyance, transfer or assignment8 &he PMCC shall thereafter cease to eCist8 &he liabilities of the PMCC shall be treated in accordance :ith eCisting la:s and pertinent rules and regulations8 CCC -'C&I#( 6!8 &ransfer of Health Insurance "unds of the --- and G-I-8 ? &he Health Insurance "unds being administered by the --- and G-I- shall be transferred to the Corporation :ithin siCty 4739 days from the promulgation of the implementing rules and regulations8 &he --- and G-I- shall, ho:ever, continue to perform Medicare functions under contract :ith the Corporation until such time that such functions are assumed by the Corporation CCC8 Deing the successor of the PMCC, PHI)H'.)&H, in compliance :ith the mandate of %8.8 116, &0( promulgated the rules and regulations implementing said act, -ection 6! of :hich provides> -'C&I#( 6!8 "ee for -ervice Guidelines on Claims Payment8 ? CCC b8 .ll claims for payment of services rendered shall be filed :ithin siCty 4739 calendar days from the date of discharge of the patient8 #ther:ise, the claim shall be barred from payment eCcept if the delay in the filing of thee claim is due to natural calamities and other fortuitous events8 If the claim is sent through mail, the date of the mailing as stamped by the post office of origin shall be considered as the date of the filing8 If the delay in the filing is due to natural calamities or other fortuitous events, the health care provider shall be accorded an eCtension period of siCty 4739 calendar days8 If the delay in the filing of the claim is caused by the health care provider, and the Medicare benefits had already been deducted, the claim :ill not be paid8 If the claim is not yet deducted, it :ill be paid to the member chargeable to the future claims of the health care provider8 Instead of giving due course to petitioners claims totaling to 'IGH& MI))I#( #(' H$(+%'+ &*# &H#$-.(+ -'/'( H$(+%'+ 'IGH&,B&*# and 132133 4P,13!,1!8139, only #(' MI))I#( &H%'' H$(+%'+ -I0&,B"I/' &H#$-.(+ "I/' H$(+%'+ "I"&,B-I0 and E!2133 Pesos 41,E76,6678E!9 :as paid to petitioner, representing its claims from 199 to 199! 4sic98 Petitioner again filed its claims representing services rendered to its patients from 199 to 1999, amounting to -'/'( MI))I#( "I/' H$(+%'+ "I"&, "#$% &H#$-.(+ &H%'' H$(+%'+ "#%&, &*# and 9E2133 Pesos 4P1,665,E5!89E98 "or being allegedly filed beyond the siCty 4739 day period allo:ed by the implementing rules and regulations, -ection 6! thereof, petitioners claims :ere denied by the Claims %evie: $nit of Philhealth in its letter dated Fanuary 15, !33, thus> <CCC &his pertains to your three hundred seventy three Philhealth medicare claims 4E1E9 :hich :ere primarily denied by Claims Processing +epartment for late filing and for :hich you made an appeal to this office8 *e regret to inform you that after thorough evaluation of your claims, GyourH E71 medicare claims :ere DENIED, due to the fact that the claims were filed 5 to 16 months after discharge8 Ho:ever, the remaining medicare claims have been for:arded to Claims Processing +epartment 4CP+9 for payment8 -'C&I#( 6! 4D9 %ule 6! 4D9 %ule /III of the Implementing %ules and %egulations of 116 provides that all claims for payment of services rendered shall be filed within sixty (6! days from the day of discharge of the patient8 Ho:ever, Philhealth Circular (o, E1B., series of 199, state that all claims pending with "hilhealth as of #eptember 15$ 1%%& and claims with discharge dates from #eptember to December '1$ 1%%& are given one h(ndred twenty (1)! days from the date of discharge to file their claim8 In as much as :e :ould li;e to grant your reIuest for reconsideration, the Corporation could no longer eCtend the period of filing CCC8 Petitioners claim :as denied :ith finality by PHI)H'.)&H in its assailed decision dated Fune 7, !3338 In a petition for review under Rule 4+ of the Rules of Court$ the Court of )ppeals ordered herein petitioner 1hilippine Health Insuran!e Corporation 21hilhealth3 to pa- the !lai4s in the a4ount of 5ourteen illion Two Hundred Ninet-6one Thousand 5ive Hundred Si7t-6eight 1esos and 0'8'%% 21'4$"#'$5/9.0'3$ prin!ipall- on the ground of li,eral appli!ation of the /%6da- rule under Se!tion 5" of R) 0905:s I4ple4enting Rules and Regulations. )!!ording to the Court of )ppeals* &he avo:ed policy in the creation of a national health program is, as provided in -ection 11, .rticle 0III of the 191 Constitution, to adopt an integrated and comprehensive approach to health development :hich shall endeavor to ma;e essential goods, health and other social services available to all people at affordable cost8 &o assist the state in pursuing this policy, hospitals and medical institutions such as herein petitioner are accredited to provide health care8 It is true, as aptly stated by the #GCC, that petitioner :as not reIuired by the government to ta;e part in its program, it did so voluntarily8 Dut the fact that the government did not <t:ist= petitioners arm, so to spea;, to participate does not ma;e petitioners participation in the program less commendable, considering that at rate PHI)H'.)&H is denying claims of health care givers, it is more ris;y rather than providential for health care givers to ta;e part in the governments health program8 It is #ur firmly held vie: that the policy of the state in creating a national health insurance program :ould be better served by granting the instant petition8 &hus, it is note:orthy to mention that health care givers are threatening to <boycott= PHI)H'.)&H, reasoning that the claims approved by PHI)H'.)&H are not commensurate to the services rendered by them to its members8 &hus, ho: can these accredited health care givers be encouraged to serve an increasing number of members :hen they end up on the losing end of this venture8 *e must admit that the costs of operating these medical institutions cannot be ta;en lightly8 &hey must also earn a modicum amount of profit in order to operate properly8 .gain, it is trite to emphasi@e that essentially, the purpose of the national health insurance program is to provide members immediate medical care :ith the least amount of cash eCpended8 &hus, :ith PHI)H'.)&H, members2patients need only to present their card to prove their membership and the accredited health care giver is mandated by la: to provide the necessary medical assistance, said health care giver shouldering the PHI)H'.)&H part of the bill8 Ho:ever, it is the members2patients :ho bear the brunt8 &hus, they are made to shoulder the PHI)H'.)&H part of the bill, and the refund thereof is subAect to :hether or not the claims of the health care providers are approved by PHI)H'.)&H8 &his is blatantly contrary to the very purpose for :hich the (ational Health Insurance Program :as created8 &9( C C C C C C C C C ;e agree. The state poli!- in !reating a national health insuran!e progra4 is to grant dis!ounted 4edi!al !overage to all !iti<ens$ with priorit- to the needs of the underprivileged$ si!=$ elderl-$ disa,led$ wo4en and !hildren$ and free 4edi!al !are to paupers &#( . The ver- sa4e poli!- was adopted in R) 0905 &'%( whi!h sought to* a9 provide all citi@ens of the Philippines :ith the mechanism to gain financial access to health servicesJ b9 create the (ational Health Insurance Program to serve as the means to help the people pay for the health servicesJ c9 prioriti@e and accelerate the provision of health services to all "ilipinos, especially that segment of the population :ho cannot afford such servicesJ and d9 establish the Philippine Health Insurance Corporation that :ill administer the program at central and local levels8 &''( To assist the state in pursuing the afore4entioned poli!-$ health institutions were granted the privilege of appl-ing for a!!reditation as health !are providers. &'"( Respondent Chinese >eneral Hospital and edi!al Center 2C>H3 was one of those whi!h re!eived su!h a!!reditation. ?nder the rules pro4ulgated ,- the 1hilhealth Board pursuant to R) 0905$ an- !lai4 for pa-4ent of servi!es rendered 2to a patient3 shall ,e filed within si7t- 2/%3 !alendar da-s fro4 the date of dis!harge of the patient. Otherwise$ the !lai4 is ,arred. &'+( But ,efore a !lai4 is filed with petitioner 1hilhealth for servi!es alread- rendered$ an a!!redited health !are provider li=e respondent C>H is re@uired to* a8 accomplish a Philhealth claim formJ b8 accomplish an itemi@ed list of the medicines administered to and medical supplies used by the patient concerned, indicating therein the Iuality, unit, price and total price corresponding theretoJ c8 reIuire the patient concerned and his2her employer to accomplish and submit a Philhealth member2employer certificationJ d8 in case the patient gave birth, reIuire her to submit a certified true copy of the childs birth certificateJ e8 in case the patient died, reIuire the immediate relatives to submit a certified true copy of the deceaseds death certificateJ and f8 in case a members dependent is hospitali@ed for :hich the member see;s coverage, reIuire the member to submit proof of relationship to the patient and to eCecute an affidavit of support8 &'4( )part fro4 the foregoing re@uire4ents whi!h often ne!essitate se!uring do!u4ents fro4 other govern4ent offi!es$ and the fa!t that 4ost patients are una,le to i44ediatel- a!!o4plish and su,4it the re@uired do!u4ents$ an a!!redited health !are provider li=e C>H has to !ontend with an average of a,out a thousand 4e4,ers and8or dependents see=ing 4edi!al treat4ent for various illnesses per 4onth. ?nder these !ir!u4stan!es$ it is unreasona,le to e7pe!t respondent C>H to !o4pl- '%%A of the ti4e with the pres!ri,ed /%6da- rule of 1hilhealth. Despite the pres!ri,ed standard pro!edures$ respondent has no assuran!e of the 4e4,ers: pro4pt su,4ission of the re@uired do!u4ents. This fa!tor is !o4pletel- ,e-ond its !ontrol. There will alwa-s ,e dela- not attri,uta,le to respondent. The unreasona,l- stri!t i4ple4entation of the /%6da- rule$ without regard to the !auses of dela- ,e-ond respondent:s !ontrol$ will ,e !ounter6produ!tive to the long6 ter4 effe!tiveness of the NHI1. Instead of pla!ing a pre4iu4 on parti!ipation in the 1rogra4$ 1hilhealth punishes an a!!redited health provider li=e C>H ,- refusing to pa- its !lai4s for servi!es alread- rendered. ?nder these !ir!u4stan!es$ no a!!redited provider will ga4,le on honoring !lai4s with dela-ed supporting papers B no 4atter how 4eritorious B =nowing that rei4,urse4ent fro4 1hilhealth will not ,e forth!o4ing. This Court will not hesitate$ whenever ne!essar-$ to allow a li,eral i4ple4entation of the rules and regulations of an ad4inistrative agen!- in !ases where their unCustifia,l- rigid enfor!e4ent will result in a deprivation of legal rights. In this !ase$ respondent had alread- rendered the servi!es for whi!h it was filing its !lai4s. Te!hni!alities should not ,e allowed to defeat respondent:s right to ,e rei4,ursed$ spe!iall- sin!e petitioner:s !harter itself guarantees su!h rei4,urse4ent. ) !areful reading of R) 0905 shows that the law itself does not provide for any specific period within which to file claims. ;e !an safel- presu4e therefore that the period for filing was notper se the prin!ipal !on!ern of the legislature. ore i4portant than 4ere te!hni!alities is the reali<ation of the state poli!- to provide 1hilhealth 4e4,ers with the re@uisite 4edi!al !are at the least possi,le !ost. Trul-$ nothing !an ,e 4ore disheartening than to see the )!t:s no,le o,Ce!tive frustrated ,- the overl- stringent appli!ation of te!hni!al rules. The fact is that it was not RA 7875 itself but Section 52 of its Implementing Rules and Regulations which established the !"day cut"off for the filing of claims. ;hile it is do!trinal in ad4inistrative law that the rules and regulations of ad4inistrative ,odies interpreting the law the- are entrusted to enfor!e have the for!e of law &'5( $ these issuan!es are ,- no 4eans iron6!lad nor4s. )d4inistrative ,odies the4selves !an and have in fa!t D,ent the rulesE for reasons of pu,li! interest. On Septe4,er '5$ '##9$ for instan!e$ petitioner issued 1hilhealth Cir!ular No. +'6)* &'/( I( #%+'% to allo: members of the (ational Health Insurance Program 4(HIP9 sufficient time to complete all documents to support their medical care claims, Philhealth is temporarily suspending the siCty 4739Bday reglementary period for filing claims8 While Sectio !" #b$% R&le 'III of the I(ple(eti) R&les ad Re)&latios of R*A* +,+! provides that all clai(s for pa-(et of services shall be filed .ithi /0 caledar da-s fro( the da- of dischar)e of a patiet% there is a eed to e1ted this period to (ii(i2e the icidece of late fili) d&e to (e(bers3 persoal diffic<ies ad circ&(staces be-od their cotrol8 4emphasis ours9 )nd then again$ on )pril "%$ '###$ 1hilhealth Cir!ular No. 5% was issued* TO 4INI4I5E the icidece of late fili) of clai(s d&e to (e(bers3 persoal diffic<ies i prepari) the eeded doc&(ets% 6hilhealth is e1tedi) the period for fili) of clai(s CCC 4emphasis ours9 The a,ove !ir!ulars indu,ita,l- re!ogni<ed the ne!essit- of e7tending the /%6da- period ,e!ause of the diffi!ulties en!ountered ,- 4e4,ers in !o4pleting the re@uired do!u4ents$ often due to !ir!u4stan!es ,e-ond their !ontrol. 1etitioner appeared to ,e well aware of the pro,le4s en!ountered ,- its 4e4,ers in !o4pl-ing with the /%6da- rule. 5urther4ore$ i4pli!it in the wording of the !ir!ulars was the !ognition of the fa!t that the fault was not alwa-s attri,uta,le to the health !are providers li=e C>H ,ut to the 4e4,ers the4selves. Dela- on the part of 4e4,ers is an ordinar- o!!urren!e. There is no need to 4a=e a 4ountain out of a 4olehill as far as this parti!ular point is !on!erned. To this da-$ 4e4,ers !ontinue to en!ounter dela- in su,4itting their do!u4ents. There was therefore no !o4pelling reason for the e7a!ting and 4eti!ulous enfor!e4ent of the rule when$ in at least two instan!es$ petitioner itself i4ple4ented it li,erall- and on the sa4e ground that it was using against respondent. 1etitioner li=ewise !ontends that respondent failed to e7haust ad4inistrative re4edies ,efore resorting to Cudi!ial intervention. ;e disagree. ?nder the do!trine of e7haustion of ad4inistrative re4edies$ an ad4inistrative de!ision 4ust first ,e appealed to the ad4inistrative superiors at the highest level ,efore it 4a- ,e elevated to a !ourt of Custi!e for review. This do!trine$ however$ is a relative one and its fle7i,ilit- is !onditioned on the pe!uliar !ir!u4stan!es of a !ase. &'0( There are a nu4,er of instan!es when the do!trine has ,een held to ,e inappli!a,le. )4ong the esta,lished e7!eptions are* 19 :hen the Iuestion raised is purely legalJ !9 :hen the administrative body is in estoppelJ E9 :hen the act complained of is patently illegalJ 59 :hen there is urgent need for Audicial interventionJ 69 :hen the claim involved is smallJ 79 :hen irreparable damage :ill be sufferedJ 19 :hen there is no other plain, speedy and adeIuate remedyJ 9 .he stro) p&blic iterest is ivolved7 99 :hen the subAect of the controversy is private landJ 139 in *(o warranto proceedings8 &'9( )s e7plained ,- the appellate !ourt* It is #ur vie: that the instant case falls as one of the eCceptions, concerning as it does public interest8 .s mentioned earlier, although they :ere not made parties to the instant case, the rights of millions of "ilipinos :ho are members of PHI)H'.)&H and :ho obviously rely on it for their health care, are considered, nonetheless, parties to the present case8 &his Court is mandated herein to ta;e conscious and detailed consideration of the interplay of the interests of the state, the health care giver and the members8 *ith these in mind, *e hold that the greater interest of the greater number of people, mostly members of PHI)H'.)&H, is paramount8 "urthermore, :hen the representatives of herein petitioner met :ith +r8 'nriIue Kalamea, PHI)H'.)&Hs President and Chief 'Cecutive #fficer, he informed them that, in lieu of protest to be filed directly :ith him, the representatives could ma;e representations :ith the #ffice of the President, :hich petitioner did to no avail, considering that the formal protest filed :as referred bac; by the #ffice of the President to +r8 Kalamea8 Deing then the head of PHI)H'.)&H, and eCpected to have an intimate ;no:ledge of the la: and the rules creating the (ational Health Insurance Program, under :hich PHI)H'.)&H :as created, he instructed herein petitioner to pursue a remedy not sanctioned by the rules and not in accord :ith the rule of eChaustion of administrative remedies8 In so doing, PHI)H'.)&H is deemed estopped from assailing the instant petition for failure to eChaust administrative remedies :hen PHI)H'.)&H itself, through its president, does not subscribe to it8 &'#( There is no need to ,ela,or the fa!t that the ,aseless denial of respondent:s !lai4s will ,e gravel- distur,ing to the health !are industr-$ spe!iall- the providers whose !lai4s will ,e unpaid. The unfortunate realit- is that there are toda- so4e health !are providers who ad4it nu4,ers for treat4ent and8or !onfine4ent -et re@uire the4 to pa- the portion whi!h ought to ,e shouldered ,- 1hilhealth. ) refund is 4ade onl- if their !lai4 is first paid$ due to the apprehension of not ,eing rei4,ursed. Si4pl- stated$ a 4e4,er !annot avail of his ,enefits under the NHI1 at the ti4e he needs it 4ost. ;e !annot turn a deaf ear to respondent:s plea for fairness whi!h essentiall- de4ands that its !lai4s for servi!es alread- rendered ,e honored as the National Health Insuran!e 1rogra4 law intended. "HERE#ORE$ the assailed de!ision of the Court of )ppeals is here,- )55IRFD. 1etitioner is here,- ordered to pa- respondent:s !lai4s representing servi!es rendered to its 4e4,ers fro4 '#9# to '##". No !osts. SO ORDERED. #anganiban$ %&hairman'$ Sandoval"(utierre)$ and &arpio"*orales$ ++,$ !on!ur, (arcia$ +,$ no part. &'( 1enned ,- )sso!iate Gusti!e Danilo B. 1ine$ and !on!urred in ,- then 1residing Gusti!e Can!io C. >ar!ia 2now Gusti!e of the Supre4e Court3 and )sso!iate Gusti!e Renato C. Da!udao. &"( Herein petitioner 1hilippine Health Insuran!e Corporation. &+( Rollo$ p. "'. &4( Chinese >eneral Hospital and edi!al Center. &5( Se!tion 4 2o3 2'3$ Repu,li! )!t No. 0905. &/( Herein respondent Chinese >eneral Hospital and edi!al Center. &0( Se!tion 4#. I4ple4enting Rules and Regulations. H ;ithin thirt- 2+%3 da-s fro4 the !o4pletion of su!h appoint4ents$ the Board shall !onvene to for4ulate the rules and regulations ne!essar- for the i4ple4entation of this )!t. &9( C) De!ision$ Rollo$ pp. '96'#. &#( Se!tion ''$ )rti!le IIII of the '#90 Constitution. &'%( )n )!t Instituting a National Health Insuran!e 1rogra4 for all 5ilipinos and Fsta,lishing the 1hilippine Health Insuran!e Corporation for the 1urpose. &''( Se!tion +$ R) 0905. &'"( Defined as a health institution dul- li!ensed and a!!redited devoted pri4aril- to the 4aintenan!e and operation of fa!ilities for health pro4otion$ prevention$ diagnosis$ treat4ent and !are of individuals suffering fro4 illness$ disease$ inCur-$ disa,ilit- or defor4it-$ or in need of o,stetri!al or other 4edi!al and nursing !are. &'+( Se!tion 5"$ I4ple4enting Rules and Regulations of R) 0905. &'4( C) De!ision$ Rollo$ p.'0. &'5( 1hilippine )d4inistrative Jaw ,- Cru<$ '##' Fdition$ pp. '06'9. &'/( Rollo$ p. '%4. &'0( -eonardo #aat v, &ourt of Appeals$ ++4 1hil. '4/ 2'##03. &'9( Na!hura$ Outline8Reviewer in 1oliti!al Jaw 2"%%"3$ pp. +4/6+4#K &orsiga v, .efensor $ >.R. No. '+#+%"$ "9 O!to,er "%%"$ +#' SCR) "/0K Aurillo$ +r, v, Rabi $ >.R. '"%%'4 $ "/ Nove4,er "%%"$ +#" SCR) 5#5. &'#( C) De!ision$ Rollo$ p. "%.
A Study To Assess The Effectiveness of Hot and Cold Application On Arthritic Pain and Mobility Status Among Clients With Osteoarthritis in Selected Hospitals at Kolar District.