PhilHealth covers kidney treatment cost

CEBU, Philippines – In a recent forum hosted by the Association of Government Information Officers in Region 7 (AGIO), Dr. Alvin Roxas, head of the Renal Center of the Vicente Sotto Memorial Medical Center, said that kidney or renal failure is considered one of the top 10 diseases afflicting Filipinos today.

Our kidneys play vital roles in body function. It filters the blood and gets rid of waste products. Most importantly our kidneys balance the levels of electrolytes in the body, controlling blood pressure and stimulating the production of red blood cells.

Once our kidneys fail completely, the options left are dialysis or a kidney transplant—and according to Dr. Roxas, the cost of treatment is alarming. For PhilHealth members, the impact of the prohibitive cost of treatment is somehow cushioned by PhilHealth’s coverage of these treatment procedures.

Hemodialysis and peritoneal dialysis, for instance, are reimbursable when done in an accredited hospital or freestanding dialysis center, or performed according to the standards set by PhilHealth (in the case of peritoneal dialysis).

These procedures are generally classified as Case Type C. As such, within a period of 90 days from first admission, if it is done in a tertiary level hospital (such as Cebu Doctors’ or Chong Hua), members may avail a maximum coverage of P28,000 for drugs and medicines; P21,000 for X-ray, laboratory procedures and others; and P1,200 for the operating room fee. Coverage also extends to the professional fee of the doctor conducting the procedure.

Hospitalization and operative procedures for organ transplant for both members and their dependents are also covered by PhilHealth. Both the donor and the recipient have to be active members or qualified dependents to be able to avail of this benefit. These will be considered two separate claims and will be processed for reimbursement separately within the maximum allowable benefit for each procedure.

In 2009, PhilHealth Region 7 processed a total of 31,618 claims for hemodialysis, amounting to a total benefit payment of P57.3 million; and 257 peritoneal dialysis claims, amounting to P1.1 million.

In the first quarter of 2010, hemodialysis claims reached 6,646 cases or a total benefit payment of P15.6 million, while only 19 claims were filed for peritoneal dialysis, amounting to about P300,000.

Benefit payment for kidney transplants in 2009 amounted to P279,813.45 or an average of P55,962.69 per claim. In 2010, first quarter benefit payment for transplants amounted to P171,956.58 or an average of P42,989.15 per claim.

At a very minimal health insurance premium, PhilHealth’s coverage for kidney failure treatments significantly reduces member’s out-of-the-pocket expenses for hospitalization cost. Yet as Dr. Roxas stressed, prevention is still the key and everybody should practice a healthy lifestyle, have a healthy diet and undergo regular checkups.

Incorporating advocacy for health care and healthy living in its 2010 corporate thrust, PhilHealth could not agree more with Dr. Roxas. In fact, its weekly radio program Ikaw ug ang PhilHealth — aired Wednesdays, 9:00-9:30 a.m. on DyLA 909 KHz — will be tackling various health care as well as PhilHealth concerns throughout the year.   (FREEMAN NEWS)