Philhealth Benefits — Case Rates Payments for Certain Medical and Surgical Cases
Last September 1, 2011, Philhealth started implementing its policy of paying fixed rates or fixed amounts to accredited hospitals and clinics for 11 medical cases and 11 surgical cases under its reimbursement scheme called Case Rates Payment.
If we count 9 case rates payment packages implemented since 2003, there are now 31 medical and surgical cases paid by Philhealth under its Case Rates Payment scheme. Other cases are paid under the regular Fee-for-Service scheme.
The fixed Philhealth payments are made directly to the hospitals or clinics. The fixed Philhealth payment is deducted from the total hospital bill and the balance will be paid by the patient.
Philhealth said that the Case Rates basis of payments for SURGICAL CASES is applied to cases managed at Levels 2 to 4 hospitals (bigger hospitals), with certain exceptions.
For sponsored members and their dependents, the No Balance Billing Policy will apply when they are confined in government hospitals or clinics. It means the Philhealth payments will be adequate to cover their expenses for these 22 medical and surgical cases and they don’t need to pay anything. In cases where patients are asked to buy certain drugs or supplies, they will be reimbursed.
These are the selected medical and surgical cases and the fixed amounts that Philhealth is going to pay to hospitals or clinics, implemented for patients admitted starting September 1, 2011:
MEDICAL CASES
| Medical cases | Case Rates in Pesos |
| 1. Dengue 1 | |
| Dengue Fever and DHF Grades 1 and 2 | 8,000 |
| 2. Dengue 2 | |
| DHF Grades 3 and 4 | 16,000 |
| 3. Pneumonia 1 – Moderate Risk | 15,000 |
| 4. Pneumonia 2 – High Risk | 32,000 |
| 5. Essential hypertension | 9,000 |
| 6. Cerebral infarction (CVA I) | 28,000 |
| 7. Cerebro-vascular accident | |
| hemorrhage (CVA II) | 38,000 |
| 8. Acute gastroenteritis (AGE) | 6,000 |
| 9. Asthma | 9,000 |
| 10. Typhoid fever | 14,000 |
| 11. Newborn care package (NCP) | 1,750 |
| Surgical Cases | Case Rates in Pesos |
| 1. Radiotherapy | 3,000 |
| 2. Hemodialysis | 4,000 |
| 3. Maternity care package (MCP) | 8,000 |
| Normal spontaneous delivery (NSD) | |
| in Level 1 Hospitals | 8,000 |
| NSD in Levels 2 to 4 Hospitals | 6,500 |
| 4. Delivery by caesarian section (CS) | 19,000 |
| 5. Appendectomy | 24,000 |
| 6. Cholecystectomy | 31,000 |
| 7. Dilatation and curettage | 11,000 |
| 8. Thyroidectomy | 31,000 |
| 9. Herniorrhapy | 21,000 |
| 10. Mastectomy | 22,000 |
| 11. Hysterectomy | 30,000 |
| Medical or Surgical Case | Fixed Payments | Year Implemented |
| TB-DOTS | 6,500 | 2003 |
| SARS | 50 to 100k | 2003 |
| Avian Influenza | 50 to 100k | 2006 |
| Bilateral Tubal Ligation (BTL) | 4,000 | 2008 |
| Vasectomy | 4,000 | 2008 |
| Cataract | 16,000 | 2008 |
| Malaria | 600 | 2008 |
| Normal Spontaneous Delivery | ||
| (NSD) with BTL | 10,500 | 2009 |
| Outpatient HIV/AIDS Treatment | 30,000 per year | 2010 |
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62 Responses to “Philhealth Benefits — Case Rates Payments for Certain Medical and Surgical Cases”
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Hello, I'm Mrs. Nors.
I write based on my experiences and research and I answer questions the best I can at the moment I'm writing my answers.
For critical questions, please ask others also to confirm my answers in case I missed something...baka lang merong updates or changes that I missed.
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Hi jill, sori hindi ko maestimate, kasi maraming variables, at hindi under Case Rate ang bypass. More likely na mas malaki pa ang mahingi nio from PCSO. Kasi merong limits ang Philhealth coverage for room, OR, medicines, PF, and lab. Tingnan mo itong chart na ito: http://www.philhealth.gov.ph/members/employed/coverage.html
Hi jhen, I suggest kausapin mo muna yong doctor kasi, ang policy ngayon ng Philhealth ay pinapa-abrub muna ng Philhealth ang cataract request bago gawin ang procedure. Expensive ang St Lukes, so malamang mas malaki ang bayaran mo kesa yong 16k or 32k (depende sa case) na mababawas.
gud day, can I refund from philhealth even if one month already passed since my child was confined. I paid cash because the hospital is not yet covered by Philhealth.
Hi evie, do you mean the hospital was not Philhealth-accredited when your child was hospitalized? And now, it is accredited? I’m not sure if you can claim. But if the hospital fills up and signs the claim forms, then perhaps you can try filing your claim. You have 60 days from date of discharge to file your claim.
But if the hospital is not accredited even up to now, sad to say, you cannot file a claim. It should be Philhealth-accredited.
Hi, My daughter was hospitalized this month, Her final diagnosis is Pneumonia with asthma component, It is included ba in Pneumonia 1 which has a case rates of P15,000? last time she was admitted in a different hospital with the same finding, we availed of the whole P15,000 but now we got only about half, as shown in the deduction in our billing. can we file a reimbursement for this?
Hi Paola, did you submit Philhealth papers to the hospital? and is there already Philhealth deduction in your bill? If there is, then that means the hospital will file a claim. There should be only one claim for every case, so I suggest you wait for the benefit payment notice from Philhealth, and then if you see that Philhealth paid 15k, you go to the hospital and ask for your refund. Keep your receipts (orig and xerox). We can’t know what illness code the doctor wrote in your claim…as there’s no pneumonia coverage lower than 15k under the Case Rate list. You can also ask the hospital’s Accounting/Collection why your deduction was only such amount as you got.
I will just ask how much will be deducted if i will undergo tonsillectomy?
Hi Lilane, tonsillectomy is not in the Case Rate list, so there’s no fixed fee amount. Philhealth will pay part of your bill, up to the Philhealth limits for room, medicines, lab, PF, OR, depending on hospital and doctor category, and illness severity. Here are the tables, if you like to see.
https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1
Good day! My child will undergo a methylprednisolone treatment for 3 days in a private hospital (philheath accredited) because she was diagnosed with lupus with nephritis class IV. May I ask what case type this falls under, please? Thanks much!
Hi Patrice, lupus or methylprednisolone treatment is not in the Case Rate list, so it will be paid under the old scheme called Fee-for-Service. It will be categorized and covered based on limited benefits for drugs, room, medicines, and PF https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1
helo,may claim status report akong nakuha from philhealth,nakalagay dun ung amount ng 2 checks amounting 46 plus and 25 plus,tapos ung 46thou e nadeduct dun 10500 para sa hospital bill,ung 25 thou eh 4500 deduct para sa doktor,saan po napunta ung excess ng cheke.leoni po from, cagayan valley
Hi leonimar, did you pay any amount to the hospital? If you did not pay anything, because everything was charged to Philhealth, all the excess Philhealth payments will go to the hospital.
But if you paid the hospital, you can ask for refund. Have copies of your receipts and your notice from Philhealth.
I would like to know if how much will philhealth shoulder for my husband’s thyroid radioactive procedure? he had one,two years ago.but im n0t sure if he will be spending the same,specially now with your case rates. thank you.hoping for a favorable reply.
Hi jelyn, I’m not sure if that procedure falls under radiotherapy, which has a coverage of 3k pesos per session, so please ask your doctor.
mgandang araw po.. isa po akong ofw dito sa riyadh ksa. nais ko pon sa inyong idulog ang aking problema dahil nsa ospital ang aking anak na may sakit na UTI at neumonia.sabi po ay covered daw po ng philheath ko ang mga anak ko.. bkit po ng sumangguni ang aking anak ay hndi daw po nka tala sa knila ang mga beneficiary ko ngunit npkatagal ko na pung ng karoon ng philheath noon pa at ktunayan po ay last year umuwi ako ng pilipinas at ng renew po ako sa POEA KSMA SA PGBAYAD NMIN ng OEC. overseas employment cert. nais kopo sana malaman kung ano po ang dapat gawin ng aking mga anak… mraming maraming salamat po.. ang aking anak n nsa hospital po ay nagngangalang IRSH FELICIANO LAYAG.. pki tulungan naman po kaming mag aama.. mraming maraming salamat po.. hihintayin ko po ang inyong tugon..
Hi Jhon, your child can still avail of your benefit even if he or she’s not written in your MDR as your dependent. You ask your wife to present to the hospital your child’s birth certificate (xerox copy for submission, and original copy for checking), copy of your OEC receipt and get MDR from Philhealth. Ask your wife to bring her IDs and your marriage certificate so she can get your MDR from Philhealth. You can email her an authorization letter authorizing her to transact with Philhealth (some do not require this, but some require it). You can scan your OEC, then email to your wife, so she can print it. Another option is to request for certification of eligibility from Philhealth, if your OEC is not clear.
Hi Ms. Nors, OFW po ako and I decided to give birth sa pinas,my problem is kakahulog ko lng po ngyon march 8 ng 1200 sa Iremit for the coverage of march 2013 to feb 2014, I would to ask if magagamit ko ba philhealth ko this coming July? and if ever magamit ko what requirements should I prepare? nabasa ko po kc sa mga comments about OEC, can I use my foreign ID and Passport cause I don’t have an OEC and copy of contract.
Thanks and regards…
Hi angee, yes, you can avail of the benefit because your premium receipt reflects March 2013 to Feb 2014 and your due date is within these dates. Yes, you can use your foreign ID and passport. Besides, you paid your premium at IRemit, so that means you work abroad as OFW. Keep your prenatal ORs (at least 1500 total) so you can avail of the prenatal benefit of 1500 — submit with your claim forms (MDR from Philhealth, premiums receipts – xerox and orig, your IDs, claim form 1 – one for you and another for baby. If you can get a Philhealth ID, it’s better.
Hi Ms. Nors, I am an OFW and would inquire if dog bite is covered by phil health my father was bitten by our dog yesterday 15th march 2013 please advise whether he can use my phil health as my beneficiary, they paid almost 8K according to San Lazaro hospital my father needs to come back 6X more in the hospital for some other treatment, is the amount paid by my father can be refunded???Also please advise whether they can use my phil health???Thanks!!!
Hi Joylin, is your father 60 years old or older? If he’s younger, sorry, he cannot yet be your dependent. If he is, yes, there’s coverage for animal bites, but the coverage is only 3k. Yes, San Lazaro is accredited. Ask your family to inquire about it at San Lazaro.
Hi Ms. Nors thank you for your response. My father is 72 years old. what are the requirements in availing this benefits. They already paid 8k can they refund the amount covered????
Hi Joylin, documents required: your MDR, premium payment receipt (keep your copy), your birth certificate, proof of your father’s age (can be senior citizen’s ID or birth cert), your authorization letter authorizing your mother or sibling to sign claim forms in your behalf, copy of your IDs, IDs of mother or sibling. The 3k can be applied for the next treatments; they need to ask San Lazaro about Philhealth processing there.
cover po ba ng philhealth ang check-up ng doktor sa opd?
Hi milagros, sorry po, check-up at opd is not covered by Philhealth. Only outpatient surgery and hospitalization
good day! my father is 60 years old and was confined in a philhealth accredited hospital. His medical case is pneumonia 1 and we dont know if we can use the philhealth benefit of my sister. She started working last december 4 2012 until now. My question is can we get any benefit from philhealth or any refund? thank you.
Hi Ms. Nors, my mother was diagnosed with tumor in ovary. She will undergo operation after we got clearance from endocrinologist for hypertension and diabetis. She is 80 years. I’m married with 3 children, my mother is one of my dependent. Can we use my philhealth even if i have 2 single sisters na dependent nila ang mother ko. Is there any difference with the rates since I’m privately employed while my sisters are government employees.
Hi cristina, if your sister’s firm was able to pay her Dec premium, plus premiums for Jan and Feb, then she can file a claim for your father. Your sister presents her birth certificate (orig and xerox) either to Philhealth for MDR update, or to hospital (if there’s no more time to update) plus proof of your father’s age (his birth/baptismal cert or senior citizen ID). Also needed: certificate of premium payments with OR nos. from employer, claim form 1 signed by employer, Philhealth ID or valid ID. I’ve read from comments here that suspected pneumonia is not covered; but I hope your father’s case gets covered.
Hi Malou, your mother will receive the same benefits, whether your Philhealth is used or that of one of your sisters…
Prayers for a successful surgery…
Hi ms Nors, I’m planning to undergo tonsillectomy at PGH ambulatory (same day surgery/no confinement). the fee estimated 25 to 30k. How much or what percent could I get when I use my Phil Health and what should I filled to get my refund.I already ask the doctor but doesn’t know the exact computation. thank you…
Hi Vic, your doctor can’t give you the exact amount because the coverage amount for tonsillectomy is not fixed, unlike those procedures under Case Rate scheme. You will get limited coverage for drugs, OR, lab and PF under the old fee-for-service scheme. https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1 Documents: Claim form 1, MDR, Philhealth ID or valid ID, premium receipts or cert of premium payments from employer if employed. http://www.healthphilippines.net/2012/03/how-to-file-a-philhealth-benefit-claim-for-reimbursement/
hi. i am to undergo an outpatient mole surgery next week at pasig city general hospital and according to the nurse,all i have to pay is a minor fee of P330. she also asked me to buy some supplies and anesthesia for the surgery. i would like to request a mole biopsy after the operation. would any of these be refunded by philhealth?
Hi marcee, outpatient surgery can be covered by Philhealth; but ask the nurse about how you go about it. Just bring your documents. Usually outpatient biopsy is not covered because it’s a diagnotic procedure.
hi! my mother undergo surgery at perpetual succour hospital in cebu in sept 2012..i supposed it was mastectomy, but philhealth rep said it was not so the case rate did not apply (22k)…so be it, we just paid the bills accordingly as presented. however, just this week i received the notice of payment from philhealth that the case was mastectomy and perpetual succour hospital was paid 22k.when asked for refund, billing incharge informed me that only the excess paid for other bills except the PF will be refunded, that is 60% of 22k = php 13.2k, we will be refunded 6k only since philhealth initial deduction was 7.2k, and that is OK. however there is no refund on the doctor’s PF. total PF billed was at 37,414.86, with initial philhealth deduction/benefit at only 7.772k, thus we paid, Php29,642.86. the philhealth notice informed us that PF is php 8.8k that is, 40% of the 22k case rate amount, therefore, we paid an excess of 8.8k – 7.772k = php 1,028.00 which i expect to be refunded to us, but which perpetual succour hospital declined to give. any suggestion on this. thanks.
Hi jeanette, it’s too frustrating to know about what that Philhealth rep told you. Was she lying so you’ll pay in cash? Or was she plainly inefficient? How can she say it’s not mastectomy and then they file for mastectomy? Whew! The hospital should refund you 1,028, because Philhealth paid them 22k. And I’m not sure how you can pressure the hospital to refund you that amount — Try asking the hospital “If I go to Philhealth and ask for an order for you to refund me 1,028, will you give the refund?” By the way, you write well. Best regards.
Tlga bang Ang claim check ng philhealth e manggaling p s Capitol ng naval,Dba dapat sa philhealth thru mail or I-claim mismo sa philhealth office Ang cheQ?kc (C-Sections) delivery ako at inasikaso ko last dec2012 ang philhealth ko. then lately lang lumabas Ang printed statement ng philhealth . Nung kinuwenta na NSA 3thou LNG Ang claim ko.of course nakkgulat tas ang explain nila kinukuwenta p daw sa naval hospital tas approval galing p sa kapitolyo.nakakawindang naman ang process d2.hindi aq baguhan sa philhealth at unfair p dun sobrang Laki ng ginastos namin at sa labas naman Ang gamot,doctor’s fee at gastusin namin.mas mgnda p cguro s city at private hospital nalang fair p cguro ang claim ko.dito Ang labo e..kaya dis month i verify ko nalang to s manila.advnce naman at yearly ang bayad ko ng philhealth then unfair Ang claim ko.dito ko LNG s naval na experience yan.
gsto ko LNG ishare at no offense sa tatamaan ha gusto ko lang kc maintidihan ganun b talga dito.?
hi Ms. Nors good evening,.i would like to ask if Ct scan,.ultrasound,room and other laboraty are covered by the Philhealth for my dependent (my father age 61 yrs old) if so ,how many percent..thanks..pls kindly reply
Hi mylene, yes, part of the costs of those things will be covered if he is confined for more than a day, and the disease is diagnosed and there’s treatment. I hope there’s a diagnosis and effective treatment.
Hi shinahlou, is this Naval in Cavite? Because you mentioned kapitolyo. Or is there a Naval hospital in Cebu? Your IP address is Cebu.
Same with you, I’m also not familiar with how some government hospitals are processing Philhealth claims, but there have been several commenters here who have described the same situation as yours. I’ve realized that the finances of some local hospitals are controlled by their local governments, even the accounting work, so Philhealth refunds are coursed through these local governments.
In other government hospitals in the provinces, where relatives have been confined, like the regional hospital in La Union and the hospital in Bio, Tagudin, the Philhealth process for these relatives have been problem-free.
I hope you can resolve your refund when you go to Philhealth and ask. best regards
Hello po, just want to inquire kasi po yun father ko na stroke pag land nila sa thailand last month. Naconfine po siya ng 1 week sa hospital sa thailand tapos inuwi po. Naka confine pa rin po siya sa hospital ngayon dito sa Pinas. Pwede po bang ireimburse kahit portion po nung gastos sa Thailand?. Tsaka po matagal na pong di nahuhulog Papa ko sa philhealth pwede po ba namin, na add ko na oi siya as dependent ko pero dapat daw pa close daw muna yun account niya. Pwede po ba yun? 62 years old na po pala Papa ko.Thank you po.
hi Ms,Nors good pm…My father(age 61) is now undergoing for 2 decho w/ doppler study,.carotid duplex scan and after that procedure they do endoscopy they are asking for 20k as of now,the question is how philhealth can help for this?
Hi Doods, ask your father to sign his letter asking Philhealth to cancel his membership because he’s already 62 years old and to register him as your dependent. Later on, he can apply for free Lifetime membership if he had accumulated 120 monthly payments to Philhealth.
About your expenses in Thailand, there’s a Philhealth rule called single period of confinement, where Philhealth do not cover the next confinement for the same illness within 90 days. Are the reasons for the 2 confinements the same? So if you make a claim for the Thailand confinement, your claim for this current hospitalization might be denied. Please ask Philhealth personnel to be sure.
Hi mylene, I think the procedures you mentioned are all diagnostic procedures, so I hope they arrive at a diagnosis and perform a successful treatment, because I’ve read that Philhealth covers part of the expenses only for cases where there’s a definite diagnosis and treatment.
Hello po mam, ask ko Lang po, na D&C po ako last march 31 2013 po at ang bill ko po ay umabot ng 70k peso sa st. Luke’s po. Tanong ko Lang po kung sa tingin nyo po kaya mga magkano ang cover ng PhilHealth po???kasi now po need ko nalang po yung sign from the doctor ilang beses narin po kasi akong pabalik balik dito sa st. Luke’s to see the doctor to sign kaso lagi pong wala
Hi Carla, you can refund 11k (Philhealth coverage: 6,600 for hospital expenses, and 4400 for PF or doctor’s fee). Hope you see the doctor soon.
Hi Ma’am Nors, I’m planning to undergo a hemmorhoidectomy in NKTI this April. I cannot seem to find what case type it is. Am I on the right track looking at the link:Revised Inpatient Care Benefits
The following are the maximum allowances or ceilings to beapplied per single period of confinement** effective April 5,
2009 admissions onwards? what case is hemmoroidectomy? ABC? Thanks so much
Hi barbara, you’re right, hemmorhoidectomy is not included in the Case Rate scheme. It will be covered based on the fee-for-service scheme –yes, that inpatient chart you’re looking at. You get coverage for OR, meds, PF, room, lab up to the limits, depending on the severity of the illness and hospital category. best regards
Hi. just want to ask if we can still avail the philhealth benefit for pneumonia.
May sister was confined and AlReady availe the the benefit under pneomonia1 (moderate risk). but after a day we come back a gain in the same hospital but this time my sister was diagnosed with liquids in her lungs. Immediate surgery was conducted yo remove the luquids in her lung… in my understanding its under pneumonia2 highrisk?
In this case can we still avail benefits? base from ur philhealth representative we cannot because we ALREADY availed the benefits of pneumonia1 same thing “LANG DIN DAW if pneumoniA2″. we can avail same benefits after 3months.
Is this true? Is it fair?…
Hi galeb, yes, that’s true. Yes, it’s not fair. They call that single period of confinement. The 2nd or 3rd confinement is not covered if it is the same illness within 90 days. I’m puzzled that the hospital was not able to see the developing fluids in her lungs during her first confinement. But you can ask for deduction for the room and board (every member has an allotment of 45 days per year for room and board) and the rest of the 15k coverage if the 15k coverage was not used up in the first confinement. I don’t know if this is possible, but if the first claim was not yet submitted to Philhealth, ask if you can pay for the first confinement (if it is cheaper) and then you file for Philhealth coverage for the 2nd confinement (if it is more expensive).
Hi again Ms. Nors.
The issue here if Pneumonia 1 or 2 is the same why put 2 different category in Sickness benefits? Pwede naman High risk nalang diba? Thats my arrugement po mam.
Yes logically its the same illnes, but i think the manner why it is been done separately is because a patient CAN avail the same bendefits without the governing rules of “single illness requirements”. That’s is base to my understanding po…
In our case we already maximize the Pneumonia 1 benefits (15k) and now because this another confinement plus surgery our case was automauca it will abviously put us into category Pneumonia 2 wich has a bigger subisidy (32k). and this all happens in a matter of 1week.
sorry for too much query mam…
Hi galeb, it’s okay to argue your point. I really wish you can refund. The phrase used by Philhealth is “the same illness”. Pneumonia 1 and pneumonia 2 are the same pneumonia; it’s just that they differ in the severity. Anyway, I suggest you go to Philhealth and ask. Or if the hospital refuses to deduct, and if you decide to try, ask the hospital to fill up the claim forms and that you’ll be the one to file with Philhealth for refund. best regards
Good day,I just wanna ask regarding the case of my wife having major operation,so called vitrectomy,we have to pay 200,000.00 pesos,Was done in Cardinal Santos medical center,in what category the case of my wife falls?thanks.
Hi Florenio, vitrectomy is not in the Case Rate list, so it will be covered under the old scheme — Philhealth deductions would depend on the category or type of illness/treatment, hospital and doctors. Here is the Fee-for-service Philhealth coverage table for a tertiary hospital like Cardinal Santos.
hi miss nors my father was confined at Uerm hospital last april 30, 2013 and he was discharged on may 4 2013. i paid the hospital bills and other expenses such as medicine, supplies and other laboratory procedures like fbs urinalysis xray and ultrasound in total amount of 16,000 pesos. my father’s case is CVA I. I just want to ask if the total amount will be refunded to me or just a part of it? by the way, my father is a senior citizen and he is.my dependent. thanks.
Hi mary joy, if your doctor wrote in the claim form the code for CVA1 including supporting details and the neurologic exam results are attached, and Philhealth will approve the claim, your 16k can be refunded from the hospital because the coverage for CVA1 is 28k.
Hi, Miss Nors. My father is 68yrs old he will be undergoing operation for his hernia at Amang Rodriguez hospital. I would like to ask how much will the Philhealth deduct on the bill?
Hi Susan, if his case is herniorrhapy, which means surgical repair of the hernia, then the coverage is 21k (12600 for hospital costs and 8400 for PF). Keep your receipts and copies of your receipts (should be in the name of your father) if you are instructed to buy supplies outside.
Hi Miss Nors, this is mary joy again. thanks for your reply. I went to UERM hospital and I gave all the requirements that they required me to submit. In my CF2 form the diagnosis of my CVA infarct left internal capsule. Is this under CVA I? I attached The hospital bills receipt which amounting to Php10,672.44 together with the other requirements but they gave it back to me because the philhealth officer there in the hospital said that it’s not needed. My other expenses receipts was only attached there in total amount of 6,000.00. Why they did not include my hospital bills which I paid in full? My father was confined in their Neuro ward which is a charity ward.is that proper Miss Nors? thanks hope you reply soon.
RE: hi miss nors my father was confined at Uerm hospital last april 30, 2013 and he was discharged on may 4 2013. i paid the hospital bills and other expenses such as medicine, supplies and other laboratory procedures like fbs urinalysis xray and ultrasound in total amount of 16,000 pesos. my father’s case is CVA I. I just want to ask if the total amount will be refunded to me or just a part of it? by the way, my father is a senior citizen and he is.my dependent. thanks.
FOLLOW – UP QUESTION
Hi Miss Nors, this is mary joy again. thanks for your reply. I went to UERM hospital and I gave all the requirements that they required me to submit. In my CF2 form the diagnosis of my CVA infarct left internal capsule. Is this under CVA I? I attached The hospital bills receipt which amounting to Php10,672.44 together with the other requirements but they gave it back to me because the philhealth officer there in the hospital said that it’s not needed. My other expenses receipts was only attached there in total amount of 6,000.00. Why they did not include my hospital bills which I paid in full? My father was confined in their Neuro ward which is a charity ward.is that proper Miss Nors? thanks hope you reply soon.
hi miss nors, mary joy again, sorry for the wrong diagnosis i mentioned. the diagnosis of my father is CVD INFARCT, LEFT INTERNAL CAPSULE. NOT CVA INFARCT. IS THAT UNDER CVA I? THanks
Hi Mary Joy, sorry I’m not a doctor so I can’t accurately answer your question. I’ve read though that CVD is more complex than CVA, or that CVA is one of the signs of CVD. If these 2 are considered differently by Philhealth, then your father’s case will be under the fee-for-service scheme (the old scheme). Under this scheme, there are benefits for meds, lab, OR, PF, room and board with maximum limits, depending on type of hospital, severity of illness and specialization of doctor. These are the charts of benefits under the fee-for-service scheme< \/a>
just want to inquire on how much is the maximum amount that philhealth will give if you are hospitalized twice or thrice within a 90 day period.
for example: first confinement is 7 days and after a month again was confined for 4 days.
is the benefit per confinement? or they will consider the total number of days in giving the second confinement benefits? thanks.
Hi Mar, the benefit amount would depend on the ilnesses and severities. But if a member is hospitalized for the same illness within 90 days, the 2nd or 3rd or subsequent hospitalization will not be covered. If the illness is covered under the old fee-for-service scheme, only the room and board will be covered in the 2nd confinement (because each member is allocated 45 days of room and board per year). But if the illnesses are different, for example, pneumonia 1 and then dengue 1 within 90 days, then both are covered.