1) Why promissory notes show up in hospital billing
In the Philippines, hospitals (public and private) commonly use promissory notes when a patient or family cannot fully pay at discharge. The promissory note functions as a written acknowledgment of debt and a commitment to pay later, sometimes with a co-maker (relative) or with interest and payment schedules.
A promissory note does not erase a patient’s rights, and it does not automatically give a hospital special powers (like holding a patient). It is mainly a tool to make collection easier by putting the obligation in writing.
2) The legal nature of a promissory note (Philippine context)
A promissory note is, at its core, a contract: a debtor promises to pay a creditor a sum of money. In hospital settings, the “consideration” (the reason the debt exists) is typically the medical services and supplies already provided.
Promissory notes may fall into two broad types:
A. Simple (non-negotiable) promissory note
This is a written promise to pay to a specific payee (e.g., “Pay to ABC Hospital”) without the “to the order of” / “to bearer” language.
- Valid and enforceable as a contract and evidence of indebtedness.
- If the hospital later assigns the account, the assignee generally “steps into the shoes” of the hospital and may be subject to the same defenses the debtor could raise.
B. Negotiable promissory note (covered by the Negotiable Instruments Law)
A promissory note becomes a negotiable instrument if it meets classic negotiability requirements, including:
- Written and signed by the maker (debtor);
- Unconditional promise to pay;
- Sum certain in money;
- Payable on demand or at a fixed/determinable future time; and
- Payable to order (“to the order of…”) or to bearer.
Why this matters: if a note is negotiable and ends up in the hands of a holder in due course, some defenses become harder to assert.
In hospital practice, many “promissory notes” are actually non-negotiable (still enforceable, just not under the special negotiable instrument rules).
3) Hospital deposits, emergency care, and promissory notes
A. Emergency treatment: deposit demands are heavily regulated
Philippine law and health regulations have adopted a strong policy against refusing emergency care or delaying essential emergency treatment because of inability to pay. As a practical matter:
- Hospitals generally should not require deposits or signing financial undertakings as a precondition to necessary emergency treatment.
- Promissory notes are more commonly presented after stabilization or at discharge, not as a gatekeeping device for emergency care.
B. “No detention” policy and discharge issues
A promissory note is often used as an alternative when the patient cannot pay in full at discharge. The legal and policy environment strongly disfavors detaining a patient solely for nonpayment. If a signature is obtained through threats, coercion, or improper pressure, that can affect enforceability (see defenses below).
4) What a hospital promissory note typically covers
A well-drafted hospital promissory note usually includes:
Parties
- Maker/Debtor: patient or responsible party
- Payee/Creditor: hospital/clinic
- Optional: Co-maker, guarantor, or surety
Amount
- Principal amount owed (often tied to a statement of account)
Basis of the debt
- Reference to hospital billing statements, dates of confinement, patient name, account number
Payment terms
- Due date or installment schedule
- Where/how payment will be made
Interest and penalties
- Stated rate (if any), when it begins, and whether it applies to installments or only to late payments
Default provisions
- What counts as default (missed installment, partial payment, etc.)
- Acceleration clause (entire balance becomes due upon default)
Collection costs
- Attorney’s fees, court costs (subject to reasonableness and court scrutiny)
Signatures
- Maker (and spouse, if relevant to property regime issues)
- Co-maker/guarantor/surety
- Witnesses; sometimes notarization (not always required, but can help with proof)
Data privacy / consent
- Limited, purpose-specific consent for billing follow-ups and disclosures consistent with the Data Privacy Act (common in modern forms)
5) Co-makers, guarantors, and sureties (critical differences)
Hospitals frequently ask for a relative or companion to sign. The label matters less than the legal effect:
A. Co-maker (often “solidary”)
A co-maker may be treated as solidarily liable if the note clearly states solidary liability (e.g., “I/We jointly and severally promise to pay…”).
- The hospital may demand payment from the co-maker without first exhausting the patient’s assets, depending on the wording.
B. Guarantor (subsidiary liability)
A guarantor typically pays only if the debtor fails and certain steps are followed.
- Guaranty has legal rules that are generally more protective than suretyship.
C. Surety (strongest for the creditor)
A surety is often directly and primarily liable, similar to solidary liability.
Practical takeaway: Many hospital forms effectively create surety/solidary liability even if they casually say “guarantor.” The exact text governs.
6) Interest, penalties, and “unconscionable” charges
A. Stipulated interest is generally allowed, but not limitless
In Philippine practice, parties may stipulate interest. However:
- Courts can reduce or strike interest/penalty rates that are unconscionable or shocking to the conscience.
- Ambiguous interest provisions are commonly construed against the party that drafted the form (often the hospital).
B. If there is no valid interest stipulation
When a contract is silent or the stipulation is defective, courts may apply legal interest under prevailing Supreme Court guidelines (the commonly referenced baseline in modern jurisprudence is 6% per annum, subject to the context of the obligation and judgments).
C. Penalty clauses
Penalties for late payment can be valid, but courts may reduce excessive penalties—especially when combined with high interest.
7) When a promissory note may be challenged (common defenses)
A promissory note is not invincible. Common defenses in hospital-bill scenarios include:
Lack of informed consent to terms
- Not about medical consent, but about financial terms (e.g., hidden interest/fees)
Duress, intimidation, or improper pressure
- If a signer was effectively forced (e.g., threatened with detention or other unlawful pressure), the obligation may be voidable.
Fraud or misrepresentation
- If the signer was tricked about the amount or key terms.
Mistake
- Wrong patient account, wrong computation, duplicate charges.
Unconscionable interest/penalties
- Courts may reduce them.
Payment, partial payment, or compromise
- Receipts, acknowledgments, installment records matter.
Non-compliance with negotiability or holder-in-due-course issues
- If the note is being enforced by a third party as a negotiable instrument, defenses may change depending on whether the enforcer is a holder in due course.
8) Enforcement and collection: what typically happens
A. Demand and extra-judicial collection
Hospitals usually begin with:
- Billing statements
- Demand letters
- Calls/text reminders (must still comply with privacy and fair collection norms)
B. Civil action for collection of sum of money
If unpaid, the hospital (or an assignee) may file a civil case. Many straightforward money claims can fall under small claims (threshold set by Supreme Court rules and periodically updated). Small claims are designed to be faster and typically limit lawyer participation during hearings.
C. Evidence that matters in court
- The promissory note (original or properly proven copy)
- Itemized statement of account
- Proof of services rendered (as needed)
- Proof of demands and payments made
- Proof of authority of the hospital representative who signed/issued demands (for corporate entities)
D. If the note is notarized
Notarization can strengthen the document’s evidentiary value and reduce disputes about authenticity, but it does not automatically make the debt “unassailable.”
9) Criminal exposure: when it can happen (and when it usually doesn’t)
Nonpayment of a hospital bill—even with a promissory note—is generally a civil matter, not a criminal offense.
Criminal exposure more commonly arises when payment involves a check that bounces (the classic risk under B.P. Blg. 22), or when there is proven fraud (e.g., identity deception). A plain promissory note default is ordinarily pursued through collection, not criminal prosecution.
10) Assignments to collection agencies or financing entities
Hospitals sometimes endorse/assign receivables to:
- Collection agencies
- Financing companies
- In-house “credit and collection” units
Key legal implications:
- Assignment does not automatically expand what can be collected; the assignee generally acquires the same rights, subject to the same defenses (especially for non-negotiable notes).
- Data Privacy Act compliance becomes important when sharing patient-identifiable information. Disclosures should be limited to what is necessary for billing/collection and consistent with consent, lawful purpose, and proportionality.
11) Practical drafting and review checklist (hospital and patient perspective)
A. For hospitals (risk management)
- Attach or reference an itemized statement of account
- Use clear language on principal, installments, due dates
- Avoid excessive interest/penalties that courts may reduce
- Specify whether liability is solidary (if intended) and ensure the signer understands
- Ensure signing is not done under improper pressure
- Maintain privacy-compliant collection practices and recordkeeping
B. For patients/families (before signing)
Confirm the exact principal amount and request an itemized bill
Watch for:
- Interest start date and rate
- Penalties and compounding
- Acceleration clauses
- Attorney’s fees clauses
- Solidary/co-maker language (“jointly and severally”)
Ask that any payment made be acknowledged with official receipts
Keep copies of everything signed
12) Common misconceptions
“A promissory note means the hospital can hold the patient.” A promissory note is a debt instrument; it does not create a right to detain a person.
“Signing as co-maker is just a character reference.” Co-maker/surety language can create direct payment liability.
“If the note has interest, it’s automatically illegal.” Interest can be valid, but it must be clearly stipulated and not unconscionable.
“Default is criminal.” Default is typically civil unless a separate criminal act exists (e.g., bouncing checks).
13) Special considerations: public hospitals, PhilHealth, and social assistance
In public and some private hospitals, promissory notes intersect with:
- PhilHealth benefit application and completion of requirements
- Hospital social service assessment and charity/discount policies
- Government assistance programs (depending on availability and eligibility)
These mechanisms can reduce the collectible principal, which should then be reflected in updated statements and, ideally, in amended payment undertakings.
14) Bottom line
In the Philippine setting, promissory notes for hospital bills are primarily collection and documentation tools. They are enforceable when properly drafted and voluntarily signed, but they remain subject to contract law limits—especially regarding consent, solidary liability, and reasonable interest/penalties—and they exist alongside strong public policy favoring access to care, particularly in emergencies.