PhilHealth limits COVID coverage

by Sheila Crisostomo (The Philippine Star), 16 April 2020

MANILA, Philippines — Starting yesterday, new case rates were implemented by the Philippine Health Insurance Corp., which limited the treatment cost PhilHealth would pay for people hospitalized due to coronavirus disease 2019 (COVID-19).

At a press conference, PhilHealth executive vice president for corporate affairs Shirley Domingo said they came up with appropriate case rates to ensure adequate financial assistance for COVID-19 patients.

“I want to make clear that PhilHealth will continuously assist people who were hospitalized due to COVID-19 even after April 14. We have the case rates now and this will ensure the sustainability of our subsidy,” she said.

There are four categories for cases of pneumonia, the usual complication of COVID-19.

For mild pneumonia, the package set is P43,997; P143,267 for moderate pneumonia; P333,519 for severe pneumonia and P786,384 for critical pneumonia.

Until April 14, PhilHealth was shouldering in full the hospitalization of COVID-19 patients. But from April 15 onwards, the new case rates shall apply.

According to Domingo, the PhilHealth Board had decided to implement full subsidy early on in the epidemic because of lack of “costing data” on COVID-19 cases from hospitals.

“Our case rates for COVID-19 are not the usual cases rates where the amounts are low,” she added.

PhilHealth had earlier released an initial P30 billion to provide accredited healthcare centers with “the much-needed liquidity to adequately respond to the pandemic.”

The amount is equivalent to three months’ worth of claims based on historical data, which will be charged to future claims.

Cagayan de Oro City Rep. Rufus Rodriguez yesterday urged President Duterte and the Inter-Agency Task Force (IATF) on Emerging Infectious Diseases to direct PhilHealth to shoulder the full cost of treating COVID-19 patients.

Rodriguez made the appeal following reports that an unnamed hospital in Metro Manila billed a “moderate case” patient P1.1 million for an 18-day confinement and treatment or an average of almost P61,000 a day.

“I am appealing to the President and the IATF to reverse the decision of PhilHealth to limit the treatment cost it will shoulder. It is the poor who will suffer from that decision, and I am sure the President will not allow that,” he said.

According to the report, the unnamed hospital charged the patient a total of P1.1 million.

The bill, consisting of more than 50 pages, included P176,945 for the patient’s stay in the emergency room, P123,665 for use of an incubator, P178,820 for x-rays and a test kit and P305,636.06 for medicines.

The report stated that the hospital required the patient to sign a promissory note before he was discharged.

Based on the announcement of PhilHealth president Ricardo Morales, the government-owned health insurance firm started limiting the cost of COVID-19 treatment effective April 15.- With Delon Porcalla