PhilHealth sets new payment rates

MANILA, Philippines — Beginning September 1, the Philippine Health Insurance Corporation (PhilHealth) will apply a new rate payment according to illness in 11 medical and 12 surgical cases in all accredited healthcare institutions nationwide.

The following medical conditions will soon receive a fixed payment rate from PhilHealth: Dengue 1 – P8,000; Dengue 2 – P16,000; Pneumonia 1 — P15,000; Pneumonia 2 – P32,000; Essential hypertension – P9,000; Cerebral Infarction – P28,000; Cerebrovascular accident with haemorrhage – P38,000; Acute gastroenteritis – P6,000; Asthma – P9,000; Typhoid fever – P14,000; Newborn care package in hospitals and lying-in clinics P1,750.

For surgical procedures, the case payment rates are: Radiotherapy – P3,000; Hemodialysis – P4,000 per session; Maternity care package – P8,000; Normal spontaneous delivery package in level 1 hospitals – P8,000; normal spontaneous delivery package in levels 2 to 4 hospitals – P6,500; Caesarian section – P19,000; Appendectomy – P24,000; Cholecystectomy – P31,000.

“These new rates are applicable to all types of members, and these include those who are employed in the private and government sectors, the lifetime members, the overseas workers, the individually paying members and the sponsored program members. They may avail themselves of these case rates in PhilHealthaccredited healthcare facilities nationwide,” said Dr. Rey B. Aquino, PhilHealth president and CEO at a conference organized by the Philippine Information Agency in Quezon City Monday.

Aquino said the case rate method had earlier been applied to conditions such as malaria treatment, HIV/AIDS, tuberculosis treatment and cataract surgery among others.

“This time we have extended the list to include the most common medical conditions that we pay for, meaning, these comprise about 49 percent of all claims that we received, processed and paid for over the last year,” he said.

Sponsored members (indigents) who were enrolled into PhilHealth by the national government, by the local government, or by private individuals or corporate sponsors, are entitled to the ‘No Balance Billing’ policy.

“It simply means that no other fees or expenses shall be charged or paid for by the patient-member above and beyond the packaged rates. They no longer have to pay the hospital or the doctor if they were admitted in any of the abovementioned medical or surgical conditions,” Aquino said.

The no balance billing policy is also applicable to sponsored members who avail themselves of outpatient surgeries, hemodialysis, and radiotherapy in accredited non-hospital facilities that includes free-standing dialysis centers and ambulatory surgical clinics. This is also applicable to outpatient packages for Tuberculosis – Directly Observed Treatment Short Course (TB-DOTS), Malaria and HIV/AIDS.