Philhealth Benefits — Case Rates Payments for Certain Medical and Surgical Cases

Updated June 2, 2014:

Since January 2014, all hospitalizations and outpatient treatments eligible for Philhealth coverage are already being covered under the Philhealth Case Rate system.  Each medical or surgical case is covered by a fixed amount.

For medical cases, 30% of the fixed amount is for Doctors’ Professional Fees  (PF) and 70% is for hospital costs.

For surgical cases, it’s 40% for PF and 60% for hospital costs.

You can no longer file your Philhealth claims directly with Philhealth.

Submit your Philhealth documents to the hospital BEFORE DISCHARGE, so the hospital will deduct the Philhealth coverage from your bill.  It will be to the hospital that Philhealth will send the check.

If the hospital asks you to sign a waiver, READ the waiver.

You can see the coverage amounts here: Procedure Case Rates and Medical Case Rates.

The coverage amounts listed in the charts below, posted in August 2011, are still correct, but the list below includes only the first procedures and conditions covered under the Case Rate program.

Article below was posted on August 2011:

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 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
PHILHEALTH PACKAGES launched from 1993 to 2010

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
Treatment for influenza A (H1N1) is now paid as Case Type A under the Fee-for-Service scheme. It was previously paid at a package rate of from 75k to 100k since 2009.


Add a Comment
  1. Hi Fatima, sori hindi covered, kasi diagnostic procedure ang MRI, at hindi ko makita sa list. Pero tanungin nio pa rin sa kung saan kayo magpa-MRI

  2. Hi Ma’am/Sir, Ask lang po sana if cover po yung MRI sa Philhealth? Thank

  3. hi po. Ang mothe ko po ay may mga series of test na gagawin sa mata nya. Angiogram at Laser surgery. May maxicare card po ang mother ko kaya lamang ay di namin alam kung ikocover ang mga ito. Magkaganun man, tiyak na Philhealth ang magagamit namin. Kung ganun po ay ano2 po kaya ang maaring icover ng philhealth pagdating sa usaping mata. Salamat po.

  4. Naaksidente po ako sa motor at may nagcrack sa may bahagi ng tuhod ko sa gawing kaliwa. tanong ko lang po kung covered ba sya ng philhealth at magkano kaya at gaano kaya katagal ang recover bago ako makapagtrabaho ulit. tnks

  5. pwede po bang magtanong?
    senior citizen na po papa ko, member po sya ng philhealth. may prostate po kasi siya, may bayad po ba pag nag undergo sya ng surgery sa prostate?
    taga davao del norte po kami

  6. hi I am a grandmother of a cerebral palsy child.he is going to be 5 years old this December and we are planning to submit him for peg tube insertion as he is removing his ngt every now and then.her mother is voluntarily paying the Philhealth. How much would Philhealth cover as to the procedure? PGH is charging us 120K as a private patient.
    Thank you.

  7. How about hysteroscopy procedure? How much will be deducted from my philhealth? Thank you.

  8. meron po akong anak na 6 yrs okd kailangan napo kasi nya maoperahan..magkano po kaya ang magagasto ko sa

  9. Ask lang po magkano po sa GI bleeding with blood tranfusion?

  10. magkano po case rate ng patellar tumor surgery with biopsy po,curretage and bone grafting

  11. Ask kolng magkano cover ng philhealth kapag sa private hospital nagpa curettage at may private doctor din.

  12. Hi,

    Asko ko lang po how much ang macocover ng philhealth kapag naamputate yung index finger sa kaliwa due to complication sa diabetes?

    Thank you

  13. good day! tanung ko lang po sana kung ang session po ng dialysis sa philhealth ay nababawasan once na ang pasyente ay na admit din po… my mother is senior citizen and she is a dilaysis patient. last august po ay may bukol po na tumubo sa leeg nya need po nya ma ct scan so eventually na admit po xa ng almost 8 days for more laboratories and also she have a neomunia…my question po is yun po bang 8 days nya sa ospital ay kabawasan sa session ng kanynag dialysis? sslamat po.. lizal bunot

  14. Ask ko lang po sana kung hindi ba pdeng gamitin ung philhealth pag lumabas ka nang ospital pero hindi pa advice nabg doctor? Hindi daw po kasi pdeng gamitin philhealth ko kasi ndi ako sa kanila magpaparaspa please i need an answer salamat

  15. Hello Mam. MAg.ask lang ako if tama ba ang ginawa ng hospital billing dept. Admitted aunt ko ng 3 days.Our Attending physician is an IM/Diabetologist. Ni refer niya aunt ko sa surgeon for his leg na infected. May debridement procedure na ginawa ang surgeon sa bedside. Nagbigay ng final diagnosis ang IM/Dia which I think the coverage is around 12k. But ang kinover ng hospital is the debridement procedure which is only around 5k. Y hindi ung final diagnosis which has a bigger coverage? Thank you po. Sana maliwanagan ako kung alin ang dapat.

  16. my son is schedule for kidney operation
    how much cover nang philhealth sa gnyang case
    13 yrs old lng son q

  17. hi.. was reading the comments here.. i find it interesting.. for those who made queries about surgeries in the government hospital, if me excess ba na babayaran.. no balance billing po lahat ng government hospitals sa pagkakalam ko if you have the phic.

  18. How much is the amount covered by philhealth for radioactive iodine treatment?

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  20. ask ko lng mag kano ang coverage ng leg amputation?

  21. Bryan July 15, 2017 at 10:21 am
    Covered po ba ng philhealth ang surgery para sa ovarian cyst

    -> Baka lang po makatulong, I have gone ovarian cyst operation via laparoscopy procedure on both ovaries, opo covered din siya sa Philhealth, I guess Php54K din niless sa expenses namin from Philhealth that time. 🙂

  22. Covered po ba ng philhealth ang surgery para sa ovarian cyst

  23. Hi maam nora tanonh ko lng po magkano po ang cover nc philhealth ung baby ko kasi my direct inguinal hernia po xa 1year and 2months plng po xa


  25. Covered po ba ng philheath ang maxillary sinusitis surgery?

  26. hi, po ask lang po mgkanu ang covered sa Hemorrhoid Surgery. at just in case nasa government hospital po nka confined mgkanu ung remaining bill na babayaran namin.

  27. hello po, mam nora ask lng po, mga magkano babayaran ng operasyon pra sa hernia or luslos? if may philhealth magkano ang cover?

  28. Na-diagnose po ang pamangkin ko with pneumonia sa govt hospital. after 6 days gusto sana namin ilipat sa private hosp kaso hindi na po ba niya magagamit ang philhealth niya dahil nagamit na ito sa govt hosp. with the same findings

  29. Na-diagnose po ang pamangkin ko with pneumonia sa govt hospital. after 6 days gusto sana namin ilipat sa private hosp kaso hindi na po ba niya magagamit ang philhealth niya dahil nagamit na ito sa govt hosp. with the same findings

  30. Hi ma’am Nora, natigil po yung contrubution sa philhealth last March 2017…nagtranfer po ako sa isang newly established company kaso di pa po kami nag huhulog sa philhealth… kung ma hospitalize po ba ako may cover ang Philhealth? Ano po pwede ko gawin para hindi maputol contribution ko habang di pa nag huhulog company namin…thanks po

  31. Hi, ask ko lang po kung magkano coverage ng UTI po.

  32. Hello, I just want to know kung magkano po ba ang coverage ng philhealth
    sa TURP? aside from philhealth meron pa bang ibang discount kapag senior citizen?



  33. Hi magkano po ang philhealth coverage sa pacemaker implant ang mother ko po ay kailangan ng pacemaker senior citizen na po 84 yeats old. Magkano po ang cover pag private hospital.
    Salamat po

  34. magkano po discount ng philhealth member pag magpapaprocedure po ng boil?

  35. Hi po! Ask ko kung ang CT scan covered po ng philhealth? Thanks

  36. Hi Cherry, sorry I can’t give the exact coverage amount. It’s better if you go to the Billing Dept and ask kasi they know the exact diagnosis. Dito sa Philhealth list, merong coverage na 5,800, merong 8k plus, meron ding 9,300, depende sa gravity ng lesion or tumor sa mouth at kung saan located.

  37. Cancer patient po ang mother ko. Naoperahan sya for the removal of mouth tumor. Ano po ba ang discount sa philhealth meron sya. Senior non paying phil health member po sya

  38. Hi Mary Jane, there are several kinds of endoscopy in the coverage list, ranging from 18k to 25k. Ang basis ng Philhealth coverage will be the final diagnosis of the doctor, and if there are several, the diagnosis with the highest cost will be the one to be covered. Have your family ask directly the doctor how much would be the endoscopy so you can prepare.

  39. Hi Jess, merong outpatient anti-TB program ang Philhealth, you just need to go to accredited facilities. I’ll email you the list. Yong regular na coverage for TB is for those confined due to TB and complications.

  40. Hello, may tanong lang po ako. Ang mother ko ay nasa hospital ,tumatae daw ng dugo. 75 yrs. Old na po sya. Gusto ng doctor ipa- endoscopy sya. Covered ba ng phil health ang endoscopy. Magkano kaya babayaran namin out of pocket? Nasa abroad ako kaya di ko alam kung magkano.

  41. Hi Ruby, dapat 15k ang coverage (10,500 for hospital and 4,500 for the doctor). It’s sad na ganon ang practice ng mga maraming hospitals na yong hospital coverage lang ang dinededuct. Request the billing dept to deduct 4,500 from the doctor’s fee. Kung ayaw, ask them saan pupunta yong 4,500, kung additional na PF ba ng doctor? o sa hospital? At puede bang irefund yon later on?

  42. Hello, im taking anti-tuberculosis medicines and check ups and laboratories every month, covered dn po ba ng philhealth yon? negative po ako sa TUberculosis bacteria and i have only PTB thank you po

  43. Hi po ask ko lang po kc po senior po yung mama ko tapOs po may pneumonia sya 15k po ba maleless sa knya sabi kc sa hospital 10500 lang daw bakit po ganun alam ko po 15k dapat Nakavonfine pa po sya ngayon

  44. Hello po. Tanong ko lng po kung covered ng philhealth ang tonsilectomy?

  45. Hi susan, hindi mo ba nabayaran ang Jan to March 2017? Pay for April May June ASAP para magamit mo this June. Or April to Sep or for one year if you like. Yong Z packages ng Philhealth ay for cancers. Coverage for myoma surgery

  46. hello miss nora .. voluntary payee aok ng philhealth kaso nitong nakaraan di ako nakakabayad.. kung magbayad po ako ng for 1 year magagamit ko ba sa pagpapaopera ng mayoma ko? at kung magkano bigay ng philhealt sa operation? or pwede ba ipasok sa z package nyo?thank you

  47. Hi po. Ask ko po sana kung magkanu ang deduction po sa philhealth sa case ng mother ko. She will go under laparoscopy. And her doctor told her that it’s between 60-70K po ang need. Tha k you so much. Hope to hear from you. God bless

  48. Kasali poba sa coverage ang magpa opera sa cyst na nasa paa?

  49. Hi Mam, ilang percent mo ang madidiscount pag bone operation?

  50. Hello po, tanong ko lang po kung magkano po kaya macocovered ng philhealth sa surgery ng kapatid ko, nilagyan kasi ng bakal ang kanang hita niya mula hip hanggang tuhod pero after 2 years nadislocate yung bakal sa bandang hip kaya Ooperahan ulit para ayusin. Salamat po.

  51. Hi mam, husband ko po naoperahan po dito sa private hospital due sa bali ang right leg. Magkano po kaya madededuct sa bill namin sa kanyang mga doctors?

  52. hi Ma’am,covered po ba ng philhealth once magpasurgery ng catharact?
    even in a private clinic?

  53. Alfredo B. Desiderio

    *Senior citizen…

  54. Alfredo B. Desiderio

    Senior citizens po ako at unemployed. Napudpod (worn out) na po and natitirang ngipin ko sa tagiliran ng bibig at tanging ito na lamang ang nagagamit ko kaya kailangan sana na malagyan ng cap dahil nagsisimula nang kumirot at mahirap nang ikagat sa pagkain. Magkano po ang tulong na maibibigay ng PhilHealth para malagyan ng “cap” ng dentista ang napudpod na ngipin ko?

  55. Hi Alex, I think puede uli kasi radiotherapy is different from thyroid surgery. Pag the same illness or procedure kasi, dapat merong 90 days na gap.

  56. Hi Carla, the patient can use Philhealth again if it’s a different illness. If the same illness, the second confinement won’t be covered. Puede uli ma-cover after 90 days from covered confinement.

  57. Pano if na confine patient then after two days discharged na .. so nagamit na philhealth pp then sa follow up check up after two days need nnmn ma confine magagamit pa ba philhealth non??

  58. Hello po,itatanung q lng po kung magagamit q po ult ang philhealth q,kc nagamit po nung april,this year po dhil naoperahan asawa q sa thyroid,,ngaun po klangan nya po ult magpa Radiotherapy,magagamit po b ult ang philhealth q,,or pd po b gamitin ult?
    Thank you po

  59. Cadence Leandra

    Hi. I am currently pregnant for 8mos. Nadiagnose ako ng pre-term labor due to UTI. Nothing was covered kazi di daw kami umabot ng 96 hours. We want to clarify how valid it is cos i remembered being hospitalized before. Di naman kmi umabot ng 96 hrs but still may kinover ang philhealth.

  60. Hi Raquel, sorry hindi ibinibigay yong sobrang coverage sa member. Napupunta sa health center. Tanungin mo na lang kung ano pang covered newborn care ang puede nilang mabigay sa baby mo.

  61. Hi Jay, pay for April to June asap. Kapag hindi paid ang Jan to March, sa June pa puedeng gamitin yong Apr to June receipt. Kapag abdominal or laparoscopic myomectomy, 23,300 ang coverage. Kausapin ang doctor kung magkano kapag merong Philhealth para you can prepare.

  62. Hi Peter, depende kasi yan sa diagnosis ng mother mo. Ang pinakamaganda diyan is pumunta ka sa billing at tanungin mo kung magkano ang Philhealth deduction. Yong dialysis ay 2,600 per dialysis per session ang coverage. Tanungin mo na rin kung paano mag-apply for PCSO assistance. Kelangang magtanong ka talaga about PCSO assistance kasi malaking gasto yang hinaharap nio.

  63. Hi Mrs Nora. un nanay ko po is may problem sa kidney so nadialysis(3 times) nakaconfine sya dito sa isang private hospital 7 days na po.
    May 80k na po un bill. how much po un deduction or un sagot ni Philhealth sa hospital bill?
    senior citizen na po sya.

  64. Paano po magagamit ang philheatlh ang mama ko may myoma at kailangan operahan tas hindi po say regulary nag babayad nga philhealth magkanu po ang coverage?

  65. Hi im raquel ask ko lng po kung 7k po ba ang noral dilivery na coverd sa phil pwede po ba ma claim ang iba kung hindi mo na use lahat like me na nanganak sa health center at 1050 lng ang nabayaran ko ayon sa BPN ko? Respect post salamat

  66. hello po pag bronchial asthma po na 2days sa hospital covered na po ba ng philhealth? thank you

  67. Hello po ma’am Nora. Ano po ang difference ng Pneumonia I sa Pneumonia II. Ang TB po ba nakacategorize sa Pneumonia II? Salamat po.

  68. Hi mam nora, ang anak ko ay naconfine sa hospital na may sakit na pneumonia 1, nakalabas na po siya. but after a week ako naman po ang nagkasakit can i avail my philhealth for the second time this month?

  69. Hi joan, if you mean yong paglagay ng catheter or cannula for hemodialysis, ang coverage is 9,700. If hindi ito, pakitanong na lang yong name of procedure para macheck natin, or ask mo na lang yong billing mismo ng hospital para mas accurate.

  70. Hi Rachel, yes, covered, merong coverage amount na 9,700, merong 12, 130, merong 14,960 up to 37,180, depende sa gagawing procedure to repair hypospadias. Ask nio yong surgeon para maka-prepare kayo

  71. gudpm po itataanong ko lng po sna kung mag kanompo:coverages ng phil health ung anak q:po:kxe mag under go ng operation na diagnose po kxe:xang my congenital:po xa since birth po meron na po xa.thanku po

  72. hi miss nora,ask q ln po sna kung magkano bawas pag naoperahan po s tyan para sa dialysis po s kidney..thankz po..God bless

  73. Hi chedz, 7k ang coverage for febrile convulsion. Depende kung anong type of UTI, ang coverage ng UTI ay lower or higher compared sa febrile convulsion. Pero dahil sa very common at maraming diagnosis ay UTI, ang alam ko merong nire-require ang Philhealth na level ng UTI severity para ma-cover, based on lab test results.

  74. Hi po, ung anak ko ngconvulsion and the test result says dahil may UTI xa kaya nilalagnat. Sbi ng doctor ang diagnosis n ilalagay is febrile convulsion, magkanu po ba ang philhealth deduction pag FC and UTI? tama po bang febrile convulsion ang mging diagnosis?

  75. Hi po! Magkano po ba deduction ng philhealth for UTI case

  76. Hi Elena, yes, pay at Philhealth. Pay for one year (2,400 pesos). Present proof that your husband is an active OFW (copy of his Balik Manggagawa, or job contract, or work visa). Bring your marriage contract in case they will require it, and your own ID. Ask for your updated MDR. You can start using your Philhealth receipt the day after you paid your Philhealth.

  77. Hi po,ask ko po sana kung pwede pa mahulugan ung phil health ng asawa ko,OFW po xa kaso po last year d n ksama sa Bakik manggagawa ang phl health kaya wala po xa hulog,kpg nagulugan po ba ngaung buwan pwede na kaya magamit ung phil health niya for surgery operation?

  78. hi po good day may luslos po kasi baby ko masasagot po ba yun?

  79. Hi Jayprill, oo, magagamit mo uli ang Philhealth kasi palagay ko hindi naman loslos yong procedure na ginamitan mo noong Sep 2016. Bukod sa reason na magkaiba ang procedure, more than 90 days na ang lumipas mula noong Sep 2016. Ang 90-day rule ay kapag ma-confine uli ang member o dependent ng parehong sakit o procedure within 90 days, isang confinement lang ang mako-cover. Yong sa iyo ay hindi naman ganon, so mako-cover ang procedure to treat your child’s loslos or hernia

  80. Hi mrs nora. ilang beses po ma avail ang philhealth benefits?nagamit ko kasi sya last sept.2016.gagamitin ko ngayon sa anak ko for his operasyon sa loslos.maka avail pa po ba ako ng benefits sa dependents?any idea po sa operasyon sa loslos.thanks po

  81. Cherry Mae Bacorro

    Hi miss Nora.nalilito lng ako sana mabigyan linaw naman.schedule cs kasi ako on june 16 dito sa Visayas tacloban city.kinalitohan ko lang inwas asking for the package and sabi 70k daw lahat2x.nag ask ako if deduct na ba dyan sa philhealth sabi Oo first baby ko sa mindanao last 2010 yung almost 80k bill ko d pa deducted ang philhealth nun so nasa mga 40k+ lng ginastos namin????

  82. Hi Josiemhy, yes, puede na uli ma-cover ang pneumonia niya kasi lampas na sa 90-day single period of confinement rule.

  83. Na confine po anak ko 6 months ago (october 2016) ng pneumonia and now pneumonia po ulit april 2017. Covered pa rin po ba sya? Hoping for your response

  84. Hi Edgar, ang coverage for moderate-risk pneumonia ay 15k. For high-risk pneumonia, it’s 32k. Depende sa diagnosis ng doctor.

  85. good day..lola ko po ay naka confine sa private hospital due to pneomonia…naka ventilator po cya.pano pa ang pag bawas sna philhealth sa bayarin?senior citizen na po sya…90 years old.

  86. Hi conchita, sorry dahil isang sakit lang ang iko-consider ng Philhealth kung sabay — yong sakit na mas malaki ang deduction ang ide-deduct. 9k ang hypertension. 12,600 ang diabetes without coma.

  87. hello po gud mom nasa hospital po.Ang case po niya ay hypetension 2 at diabetes .ask ko po if per case po ba ang deduction and how much po.

  88. Hi Scarlett, depende sa sakit or surgery. Fixed amount per illness or surgery. Halimbawa pneumonia level 1. Fixed na 15k ang deduction ke malaki o mas maliit ang hospital bill.

  89. Pag na confine po ba ang dependent. Depende po ba sa total hospital bill ang deduction?

  90. Hi Carol Jean, yes, inclusive na. 4,500 ang doctor’s fee, at included na siya doon sa 15k na coverage.

  91. Carol Jean E. Diploma

    Hi Ms Nors, Pneumonia 1 is Php15,000, inclusive Doctor’s fee po ba?

  92. 2 days lang po ba na confine s hospital ang pasyente hindi na po sya covered ng dehydrate po sya at uti ang case

  93. Hi Raymond, sorry hindi covered ang outpatient na diagnostic procedure kagaya ng biopsy, CT scan or MRI. Pag in-patient naman, essentially, hindi na rin mako-cover ang mga diagnostics kasi mapupunta yong coverage sa costlier treatment procedures. Pero subukan mo pa rin tanungin doon sa hospital bago ma-biopsy

  94. Hi, my father will undergo biopsy to check if he has prostate cancer. He is 67 yo, and I believe outpatient lang po yung procedure. Is it covered by Philhealth? How much? Thanks

  95. Hi faith, sorry, yong CT scan, kung magawa as outpatient, hindi covered. Kung admitted naman, makakasali siya sa total hospital cost, pero merong limit, depende sa kung anong operation ang gagawin.

  96. Hi, my father has to undergo ct scan and operation . are these two cover by phlhealth?

  97. Hi Jonaly, meron siyang Philhealth membership? At active? Sabi mo dinala nio sa drug rehab, tanungin nio yang rehab center kung Philhealth-accredited sila. Merong 10k na coverage for drug rehab for those diagnosed with acute physical symptoms of use of amphetamine-type stimulants such as methamphetamine, cocaine or ecstasy.

  98. Hi po gusto ko pong itanong kung magagamit po ng tita ko ung for peace nya sa rehab kc pinarehab nmin po sya kc muntik. Na po kc syang mabaliw dahil sa pagamit nya ng droga.

  99. Yung anak ko po mag undergo ng operations. Tonsillectomy at andenoidectomy at saka tonsillopharygoplasty sa isang private hospital. May hmo naman po pero magkano ang covered ng healthcard po sa ganitong operation? Per illness din po ba?

  100. Good day. Tanong ko lng po, pwede po bang magamit ulit ang Philhealth 7 days after ma discharge nang pasyente? Nilagyan po kasi sya nang ij catheter ang mama ko at nag simula naring mag dialysis, a week after po syang ma discharge nilagnat po sya at sepsis daw po ang diagnosis. Now sabi nang kapatid ko hindi daw po pwede ang philhealth kasi daw dapat after a month daw po ang allowed bago magamit ulit ang philhealth. Salamat po

  101. Hi, I will undergo CS this coming April,I was supposed to be operated for ovarian cyst however I requested that this be done simultaneously with my delivery. My doctor also advice that need to undergone appendectomy as well. Does the Philhealth will cover the Surgical Procedures of the following?
    Cesarean Section-19k

    Pls advice. Thanks

  102. hi mam nora,nkaconfine po ang tatay ko dhil sa pnuemonia and hypertension,nsa 21k npo ang bill much po kya ang discount pag gamitin philhealth and senior benefits nya.salamat po.

  103. Good morning po.
    Naconfine po ako for 2 days due to amoeba. My room mate din ako with the same case and same doctor din pro 4 days cya, but when i look at my docs fee mas malaki pa po ang sa akin kysa sa kanya. Bakiy po ngkaganon?

  104. Hi Ma’am,

    Ask ko lang po kung macocover pa ba ng philhealth yung case ng dad ko. sa first hospital po ang diagnosis ay Stroke Lacunar Infarction(28k coverage) na avail na po namin ang 19600 coverage sa hospital bill and 8400 PF fee. total of 28k. but we transferred him po sa PGH where in the diagnosis after doing MRI is basilar artery stroke. under different type of stroke sila sa philhealth if i am not mistaken. 38k po ang allotted sa hemmorhagic stroke kung saan nag fall ang basilar artery stroke. maaavail pa po ba namin ang 38k?

    thank you very much for answering all our questions! such a big help for those who are in need!

  105. gudam husband was admitted due to acute MI then he was also diagnosed for having moderate risk pneumonia..according to the philhealth representative in the hospital we could only avail the package benefits for MI and nothing for pneumonia..our bill reaches 83k excluding medicines we purchased outside which reach more or less it right that we can’t avail the package for pneumonia?my husband needs to undergo angiogram procedure how much is the package for such procedure and how can we avail it..thank you..

  106. Hello Maam.. Ask ko lng po sana kung magkano ho ang sagot ng philhealth for scoliosis surgery. Naka sked ho kc niece ko ng scoliosis surgery sa orthopedic hospital. 17 years old cya at voluntary member ng philhealth ang mother nya. Thank u po.

  107. Ask ko lng po sana kung magkano ang package rate ng philhealth for scoliosis surgery. Niece ko ho kc ay na ka sked for said surgery sa orthopedic. Voluntary member lng ang mother nya at 17 years old lng ho ang niece ko.

  108. Hi nikki, yes, covered siya kasi dependent mo siya, kahit sabay kayo, basta yong diagnosis niya ay nasa Philhealth list. Ask the nurse about the Philhealth form for your baby, or have someone ask the billing department. Yes, fixed din ang coverage, kahit higher yong contribution.

  109. hi po. itatanong ko lang po sana kung maccover po ba ng philhealth ung confinement ng baby ko due to infection(high white blood cell).kaka’cs ko lang po nung 14, then feb15 po naconfine na po xa.. magkano po kaya ung deduction ng philhealth para po sa ganong case?
    fixed din po ba ung deduction kahit mas malaki po ung contribution?
    salamat po..

  110. Hi Cherrey, doon ba sa bill, walang Philhealth deduction for PF? If none, wait for the benefit payment notice from Philhealth, and check the allocation for PF, then present it to the hospital for refund, including all hospital docs. Pero it’s sad that many hospitals do not refund, at sasabihin nila dagdag pa yong galing sa Philhealth para sa PF ng doctor. Try nio lang.

  111. Hi po. ask lang po ako. My husband po had undergone herniorraphy. But we had paid separately the doctor professional fee in cash. Possible po ba na mareinbursed po yung binayad sa doctor?

  112. Gud day po sa inyo Sir/Madamme:my mother is a senior citizen and had a stoke(infarct),today is her 11th day in the ICU,complicated with pneumonia.If she were to stay in the hospital yet for a month or more,ma’am/sir,may we please know how much of her hospital bill can be covered?

  113. Hi lolita, sorry pero fixed ang coverage ng Philhealth at maliit lang na portion ang iko-cover compared sa total bill. Tanungin dapat sa doctor at hospital kung magkano ang total bill after Philhealth deduction para maka-decide ang family. Tanungin din kung merong PCSO liaison officer ang hospital para ma-estimate kung magkano ang mahihingi sa PCSO kung mag-apply for assistance. Take care and prayers for you for strength

  114. lolita Agustin Fernando

    hi po,ask q lang po sana,kc yung father is 76 yrs old na po at need daw niya maoperahan sa ulo kasi may namoo na dugo sa utak nea,sa ngayon nasa hospital po siya,divine mercy hospital,dapat po sana sked ng surgery niya sa friday po,feb.10,pero mejo alanganin po kc need ng malaking pera,ask q lang po sana qng meron po ba aqng makukuhang financial na tulong at kung mag kaano po.ofw po aq d2 sa taiwan.maraming salamat po sa tutugon.bayad po aq ng philhealth contribution q ng 1year,mag eexpired po ngayong april.

  115. Hi mik, sorry konti lang ang mababawas compared to the total bill. Isang procedure lang ang iko-cover ng Philhealth at malamang it’s hysterectomy kasi it’s the costlier procedure. Philhealth’s coverage for abdominal hysterectomy is 30k lang (12k for doctor and 18k for hospital costs). Yong senior citizen ID ay makakakuha ng discount doon lang sa certain medicines. If you decide so, you can ask other hospitals or surgeons or ob-gynes.

  116. hi po for operation kasi ang mother ko, hysterectomy and removal of cyst on the left side. sabi ng doctor around 150-170k ang magagastos, she has phil health and senior citizen ID. Gusto ko lng po malamaan if how much kaya ang discount na mababawas. salamat po

  117. MS. NORA,
    please pasagot naman po yung question ko.
    thank you po.

  118. Hi alex, yes, 38k ang Philhealth deduction kung CVA 2 or hemorrhagic stroke yong diagnosis sa father mo. Yong 38k coverage is allotted as 11,400 for doctor and 26,600 for hospital costs

  119. hi my father was admitted due to cva so
    max is 38000 k ang ibbwas kpag isesettle n ang bill im ofw thnx

  120. hello po for operation kasi ang mother ko, hysterectomy and removal of cyst on the left side. sabi ng doctor around 150-170k ang magagastos, she has phil health and senior citizen ID. Gusto ko lng po malamaan if how much kaya ang discount na mababawas. salamat po

  121. hi ung anak ko po na admit last week sa Manila med 4 day my nomnya risk 1 itanung k lng po sa philhealth po ba may kahati ang doctor s na imbis nka discount po ako ng 15k ang philhealth po, naging 10,500 n lng po kc dw my Hati ang doctor sa halagang 4,500.

  122. Hi Jinky, total coverage for appendectomy is 24k pesos (14,400 pesos — for hospital expenses; 9,600 pesos — for doctor).

  123. Yong brother ko po nsa ospital ngaun nag undergo ng acute apedixites operation at umabot na ng 100k ang bills namin magkanu kaya ang cover ng philhealth nun…thank you po.

  124. Hi mam nora ofw po ako 2years kona po di na rerenue ang philhealth ko pwede ko po ba pabayaran sa family ko 2400 pesos.thanks po.

  125. mam good evening,i want to ask about using philhealth within two times (JAN 14,2017 and FEB.3,THIS COMING FRIDAY)due to my wife kidney stone shockwave,first was made last Jan,14 in left side and on Feb 3 must under go shockwave again in right portion of kidney,is it possible covered by philhealth?

  126. Hi how much po mababawas sa bill my daughter will undergo surgery tonsillectomy

  127. Hi,ask ko lng po bakit di tinanggap ng phihealth section sa hospital ang philhealth nmin kasi daw na aksidente ang asawa ko,bakit di po ba covered ng philhealth ang accident sa binabayaran nmin?thank you po in advance

  128. Ask ko lang po kung d po ba sakot anh doctors professioonal fee? Yung pmankin ko po was diagnosed with pneumonia and stayed at hospital fir 5 days.. ang mahal ng doctors fee umabot

  129. Hello ask ko lng po if may possible surgery regarding sa extraction of third molloar inside the maxillary sinus… magkano po ung u ccover ng philhealth? thanks

  130. hi po ask lang pokung magkano po ang mababawas ng philhealth sa operation ng scoliosis

  131. Hi Quennie, sorry I’m not sure of the amount. I can see only these 2 on the list: Excision of tongue lesion – coverage is 9,300. Excision of cyst or abscess – coverage is 5680. It’s better that you ask the billing dept. It’s most likely that you will pay the whole PF of your specialist doctor because you’re choosing him. It’s also a common practice among government hospitals to have the patient buy supplies or meds before the surgery if these are not available at the hospital. If this is the case there, have your receipts in your complete name and keep copies.

  132. Hi I am a dependent of my husband. I opted to have my surgery in a government hospital in Cebu Vicente Sotto Hospital. It’s to remove a mass or tumor in my tongue. How much should I expect to be deducted from my bill? And If I will choose my own specialist doctor, will Philhealth pay them as well? I am sure they will ask for a separate Professional fee too.Thanks.

  133. Danilo Divinagracia

    my father diagnosed with kidney stone and referred by doctor for operation and adviced to prepare 50k pesos. my father is a senior citizen and our family cannot afford for that amount, and my question is… is there anyway that my father be operated for free? thanks! please!

  134. Hello, ang brother ko po ay nagdadialyis at nung 2016 naubos na po ung 90 sessions sa Philhealth. Naconfine po sya last December 2016 at malaki po ang naging bill nila sa hospital dahil hindi na binawasan ng Philhealth dahil ubos na raw po sa dialyis. Tama po ba yun? Thanks in advance for your reply.

  135. Hi po aask ko LNG po LNG sakop ba ng biophsy ang philhealth ..may breast lump po kasi aqo at need ko magpabiophsy …covered po ba xa ..a??at magkno magagastos po ???

  136. hi, nakaconfine po ako mag 3 days na. measles lang pala, ang problema ko po yung private duty nurse or special nurse ang mahal, hindi pa covered ng HMO ko, macocover po ba yun ng philhealth if ever?

  137. Hi yhen, fixed ang Philhealth deductions, depending on the illness. At isang illness lang ang kino-cover, yong more expensive. Kung UTI yong mas costly, at UTI during pregnancy ang diagnosis, 4k ang coverage (2,800 sa hospital; 1,200 sa doctor). Kapag admissible UTI ang diagnosis, 7,500 ang coverage.

  138. hi
    na confine ako for 2days due to pre term labor and infection sa uti.. ilang percent kaya ma dededuct sa total bill ko..kompleto naman kami ng naipasa sa philhealth bago p ako ma admit nasa 15k n kc ang bill nmin.


  139. Hi Rosalie, your sister can avail of 90 sessions of hemodialysis per year, with a coverage of 2,600 pesos per session (equivalent to 2,600 x 90 sessions = 234k pesos per year. Yong hindi ma-cover ng 2,600, yon ang babayaran ninyo. Covered pa rin siya for confinements for other illnesses if needed (45 days per year), with fixed coverages depending on the diagnosis. Find a clinic offering a Philhealth dialysis package na konti na lang ang idagdag ninyo.
    If it’s peritoneal dialysis, every 4 days of dialysis is equivalent to 1 day na ibabawas sa 90-day allowance per year. The insertion of the cannula has a separate coverage.
    Some info here: Hemodialysis

  140. may sister is undergoing dailysis what are the benifits covered by philhealth?

  141. Hi question lang po. My father was diagnosed na may high risk pneumonia. Pero naintubate siya and naconfine ng 9 days.yung fixed rate lang ba ng pneumonia ang mababawas sa bill namin? Or may ibang rate yun pag naintubate sya. Thank you and Godbless.

  142. Hello po.ask lang mgkano po ang coverage ng jaudice at sepsis?Thanks po and more power.

  143. Good day.magkano po ba coverage sa meningitis.maraming slmt po

  144. Hi, ask ko lang po naconfine po kasi aq ng Dec. 13-15 2016 e ginamit q po ang philhealth q. Manganganak po aq sa February magagamit ko poba ulit ang philhealth ko? Sana masagot po Salamat.

  145. Hi Mam. Magkano po ba ang coverage sa thyroidectomy?

  146. Hi Ms. Nora. I’m an individual payor. I underwent eye laser last dec 7, 2016, but was unsuccessful. Sabi ng doctor kailangan daw ulitin yung procedure, pero sa dec 19, 2016 ko pa daw pwede magamit ulit ang philheath benefit. Hindi po ba pwede agad magamit ang philhealth for the same sickness? Thank you.

  147. Yum po bang pelvic laparoscopy ay kabilang sa hysterectomy? Magkano po ba ang benefits na pwede para sa pelvic laparoscopy?

  148. Good morning po!..nahospital po anak ko ngayon..And findings po is pneumonia and amoebiasis..magkano po ang philhealth nyan?

  149. Hi Mario, how did you know it’s not included? Did the doctor or hospital say it’s excluded? If you haven’t asked yet, ask the doctor or hospital. I can’t search the Case Rate list because I don’t know the exact name of the procedure done. I can’t see “brain injury” or “cerebral hematoma” in the list


  151. Hi David Ken Toca, yes, dependent nio ang mga anak nio kasi minors pa lang sila. Sino sa inyo ang merong Philhealth, puedeng dependent niya ang mga anak nio. Ipa-update lang sa Philhealth ang MDR nio para maisulat ang names nila as dependents sa MDR. Bring their birth certificates (original and xerox). If both of you have Phihealth, mamili na lang kayo kung sino ang ipapa-update. Yon na lang madaling ipa-update. Kahit naka-confine na, puede pang ipa-update, or ask the hospital kung puedeng birth certificate muna ang i-present nio.

  152. hi po s inyo ako po si David Ken Toca my ka-live in at my 2 anak n po kmi ang panganay po nmin ay 2 taon n at ang bunso ko ay 3 wiks plang.ask ko lang po sakop po b ng philhealth ang anak nmin kung sakali ma-admit siya sa hospital sa sakit na Pheumonia?salamat po

  153. Hi Arsenia, yes, if you pay for Oct to Dec, you can use this receipt starting December 1, 2016.

  154. Hi po last Aug lng po kmi ng umpisa mg byad ng philhealth tapos mg byad uli ako ngayon pra s last quarter pwede n po b magamit nmin yong philhealyh ngayon? Thanks po

  155. Is Amoebeasis covered?

    ! was confined of Amoebiasis; Acute Gastroenteritis. with moderate dehydration. I found out in my billing statement, no benefit given to me. I read below the billing statement. Phic not compensable due to final diagnosis. Why?

  156. Hi tanong ko lng po.. kung ngayon buwan plang ako kukuha ng philhealt magagamit ko nba sya sa march nextyear kung kalahating taon nman babayaran ko?

  157. Hi! Covered po ba ang cauterization ng hemorrhoids?

  158. Hi Mr. Julie, sorry I can’t find varicose veins in the Philhealth’s Case Rate lists. Neither the words sclerotherapy or vascular surgery. Anyway, here’s how to file your claim for overseas confinements.

  159. Hi Karen, coverage is 7,500 (2,250 for PF; 5,250 for hospital cost). UTI should be admissible, meaning merong mga symptoms na dapat talagang for confinement ang severity ng UTI)

  160. Hi Ma Jovelyn, coverage for tonsillectomy is 18,000 (8,400 for PF and 9,600 for hospital cost)

  161. Good day, How much po ma.cover ng Philhealth sa tonsillectomy?thank you.

  162. Hi po. Magkano po ang macover ng philhealth for uti? Dependent ko po at voluntary member po ako. Thank you.

  163. Mr. Julie M. Nelmida

    Good day maam/sir,presently im working here in saudi,now my case was like this.I have been a surgical treatment of my varicous vein and it is already done last Nov.3,2016 here in saudi Al Mana hospital in Alkhobar.And i want to file a claim for insurance,then how much could i receive amount for this,and what is the step by step procedure,what document requires to file this claim,Hope you response me soon.Thank you.

  164. Gysto ko nrin po itanong. Voluntary payor po ako, n stop lng byad ko nung 2012. Ngayon po ofw na po ako, gusto kong ipagpatuloy yung bayad, pero na check ko yung status ko naging indigent, pati yung benneficiary ko naging invalid. Ano po b ggawin ko pra maging ofw yung status ko dun, e kasalukutan po akong nsa Dubai. pg ngbyad ba ako dito s Dubai, automatic n maging ofw nayung status ko?. Salamat

  165. Hi, ask ko lng po kung cover ng philhealth yung laporoscopy surgery? Thanks po.

  166. Hi, ask ko lng po kung cover ng philhealth yung laporoscopy surgthanksery?

  167. Coverage po ba ng philhealth ang operation for thyroid???? how much after discount?

  168. Hi Dexie, coverage for ovarian cystectomy (removal of ovarian cyst) is 23,300. Coverage for total hysterectomy (removal of ovaries, uterus, cervic and fallopian tubes) is 30k pesos.

  169. Coverage po ba ng philhealth ang operation for ovary????

  170. Hi Aisadel, puedeng 6k, 6100 or 12800. See this: Philhealth coverage for Gastritis

  171. Good pm po.. inquire lang pobof mgkano ang case rate ng gastritis?

  172. Hi Esperanza, mas mabuti pa ang company na hindi nagbabawas ng Philhealth kesa company na nagde-deduct pero hindi naman nagre-remit. Sana sinabihin na lang kayo na mag-register as Individual Payors. Ang coverage ng gastroenteritis ay 6k. Dapat bayaran ng company mo ang 6k kasi yan ang babayaran ng Philhealth kung naka-file ka sana. Walang regulation na 20%. Saan nila pinulot yong rule na yon? Okay, kung tatawad yong company, pinaka-minimum na dapat yong hospital cost na 4,200, kasi sure na sure yon na binabawas sa hospital kung merong Philhealth. Meron kasing ibang hospitals, yong PF (1,800), hindi binabawas sa bill, dinadagdag sa bayad sa doctor or sa hospital mismo, dahil matagal daw magbayad ang Philhealth.
    I hope makahanap ka ng ibang company. Kumusta naman ang SSS nio? Puede ring mag-file ng SSS sickness benefit kung wala ka nang sick leave, at kung nag-leave ka ng at least 4 days. Required na rin that all companies file their Sickness and Maternity Benefit Payment thru Banks form para maka-file ng sickness or maternity benefits ang mga employees.

  173. Hi po. Ako po si espie. Na confine ako last oct 28 to 29,2016. Employed po ako pero abg lumabas sa info ng hospital ay NO contributions and self employed. 17 months na akong employed and nag deduct na sa akin every month. Gastroenteritis ang diagnosis sa akin. Nagbayad ako ng 6k sa hopsital. wala daw po makukuha sa philhealth.sabi sa company ay 20% lang ang pde mabalik sa akin. Tama po ba un?

  174. Hi eleanor, yes, puede. Kung gamitin mo this month of Nov, ang receipt na gamitin mo is any payment for any 3 months within June to Nov.

  175. Puede ko po bang mgamit uli ang philhealt ko sa panganay ko since nagamit ko po last april 2016 sa bunso ko?

  176. Hi clarita, yes, puede. Ang coverage for myomectomy is 23,300 pesos (12,600 for Hospital and 10,700 for PF). Ask your surgeon how much you will pay if you use Philhealth.

  177. Hi Reylin, sorry I’m not sure kung yang type of warts mo ay covered. Ang coverage for removal of FLAT WARTS OR MOLLUSCUM CONTAGIOSUM, MILIA, ALL LESIONS is only 5,680 pesos (pag hospital) at 3976 pag clinic. Ito ang documents required for overseas treatments. File within 180 days from discharge.

  178. Hi Douglas, sorry, I can’t see MRI on the coverage list, and based on comments on this blog from patients, Philhealth does not cover a lot of outpatient diagnostic tests, like MRI, CT scan, ultrasound, etc.
    For hospitalization, the SOP is for you to submit your Philhealth MDR and premium payment receipt and claim form 1 to the hospital so the coverage can be deducted from the bill before discharge. Ask the hospital too

  179. Hi, good afternoon Mrs Nora, Ask ko lang po pag nag pa opera ba ng myoma sa private hospital m pwede ko ba gamitin ang senior philhealth ko?

  180. Reylin.salvador sajor

    Hello, Ako ofw ng Hk.gusto kong paalis tong warts ko sa my side ng armpits ko and its cost 1000+hk $ marereinburse ko po ba? thanks:-)

  181. My Dr prescribed an MRI at a cost of 15,200php. How much of that can be covered by PhilHealth? The general hospital does not have a machine so I will be going to the Private hospital which does not like to wait for PhilHealth…. Can I pay out of pocket and get reimbursed?
    Thank you

  182. Hi, ask ko lang po kapag operation ng ankle fracture ang bali ng buto. How much po kaya yung rates?. Ooperahan m po kasi ako ng 2nd week ng nov. Thank u po

  183. Covered ba ng philhealth ang CT scan or MRI kung may 1 day confinement??

  184. Hi Juliana, sorry for the delayed reply. And sorry hindi sagot ng Philhealth ang ultrasound at CT scan. Dapat punta sa hospital na Philhealth-accredited. Fixed amount ang sagot ng Philhealth sa bawat kind of illness, ke naospital ka sa public o sa private, sa mas mura o sa mahal. Present your Philhealth MDR and premium receipt upon admission. Fill up the claim form.

  185. Ang aking ina po ay GSIS pensioner,subalit tila walang gsis accredited na ospital d2 sa Laguna.
    Siya po ay philhealth member din.
    Maari ko po bang malaman kng ano ang benepisyo na maaari niyang mkuha mula sa philhealth.
    Siya po ay nangangailangan ng agarang lunas sa knyang gall bladder problem.Ilang porsyento po ang dicount for laboratory test like ultrasound and citiscan?
    Paano po ang dapat gawin kng maconfine sia at nais naming gamitin ang kanyang philhealth?
    May opisina po ba ang philhealth sa Laguna?
    Maraming salamat po agarang tugon.

  186. Hi Grace, puedeng magamit uli ang Philhealth kahit confined for the same illness kasi more than 90 days na ang lumipas since last May. Ang 90-day single period of confinement rule ay ganito: isang Philhealth coverage lang ang magamit kapag na-ospital uli within 90 days.

  187. How to know our new discountbh for senior even we used it last may for her hospitalitaiob

  188. Hi, does epilepsy or seizure disorder exempted to Philhealth benefits? If yes, why so? Thank you.

  189. Hi Cjay, yes, legit yon, kasi website nila. But you still need to go to Philhealth with your ID and get your MDR and card, if available. The hospital requires MDR and premium receipt.

  190. Hi joyce, kung consultation lang, hindi covered. Pag ma-confine ang coverage for nephrolithiasis is only 4,000 (2,800 for hospital costs and 1,200 for PF)

  191. hi ms nora, ask ko lang kung legit po ba yunh online registration sa philhealth ? kasi sa online lang po ako nag.register nun. at mag 1year ko na po sya hinuhulugan. kasi po baka mag pa opera po ako ng appedix removal. malaking tulong din po kasi yung philhealth kung nagkataon. thanks !

  192. thank you po mam nora sana nga po 12200 para konti lng po byaran namen

  193. Hi may, ito lang ang makita ko sa list: Chronic asthmatic (obstructive) bronchitis NOS; Chronic emphysematous bronchitis NOS; Chronic obstructive bronchitis NOS. Coverage is 12,200 (3,660 for pf and 8,540 for hospital). Ask also the billing dept

  194. hi po kanina lang natapos ako maultrasound at result is nephrolitiasis.. cover ba ng philhealth if ever mgconsult ako doctor?

  195. Gudpm anak ko po ay ngkaron ng bronchatis mgkano po kaya ang cover

  196. hi how much po ma avail ko sa philhealth for tocolysis procedure? thank u nasa 30k na bill ko wala pa dr. fee and magagamit ko pa ba philhealth if i sked ako ng cs? thank u

  197. Hi shella, ang coverage for CONGENITAL HEART DISEASE ay 11,600 (3,480 for pf; 8,120 for hospital costs). Ang for newborn sepsis ay 11,700 (3,510 for pf and 8,190 for hospital cost). Usually isang illness lang ang kino-cover; merong exceptions pero hindi ko alam kung exception ang 2 illnesses na ito. Tanungin nio sa billing.

  198. hi mrs nora 1 month n po pmangkin ko sa ospital malakas pa sya pgpasok ngayon nanghina na sya sa dami ng lab test at sad to say wla padin diagnoses.. ilalabas na po sana namin.. pag ppirma po ba kmi ng waiver hndi po mggmit ang indigent phil health nya po..naawa n oi kc ako sa baby.. pls po help..09093141397 text nyo po ako jan kung anu dapat gawin

  199. hi po, yung anak ko po may blood sepsis and may congenital heart disease, mga magkano po kaya madededuct sa hospital bill po namin.?

  200. Hi May, yes, pareho lang ang coverages sa private and government hospitals, basta hospital ang category at hindi primary health care facility or emergency clinic.

  201. Hi Jhen, I checked uli yong coverage ng typhoid fever sa Philhealth list at 10,000 nga. So tama yong hospital na 10k ang coverage. Ewan kung bakit 14,000 ang nasa post ko noon. At yong mga other online articles din, ang coverage is 14k. Baka binabaan nila. Pneumonia at asthma ang alam ko na dapat 4 days ang confinement. Sorry hindi ko sure pag typhoid fever at hindi ko makita yong qualifications sa typhoid fever. Pero dapat ang result ng widal test or typhidot test ay typhoid fever diagnosis.

  202. Hi Cha, yes, kapag naospital ka in the 3rd month of the quarter at kapag nagbayad ka ng premium a day before naospital ka. Halimbawa, nabayaran mo ang July Aug Sep kahapon or days before pa, then naospital ka ngayon na September, yes, puede kang macover. Ang sitwasyon na hindi ka macover ay halimbawa hindi mo nabayaran ang Apr to June at kababayad mo ng July to Sep, then naospital ka July or August, hindi ka pa macover. Ang rule is premium payment of at least 3 months within the past 5 months including current month.

  203. Hi miss Nora.nabasa ko din po dito na basahin dapat ang waiver.kahapon po sa kalituhan eh pirma at fill up lang ako sa mga form.Hindi ko na nkita kung may waiver dun.isang pagkakmali po.pero kung sakali nga po na NASA waiver pala yung 10000 na unang sinabi sa akin na cover para sa typhoid f.any po ang maaari Kong gawin?maraming salamat po

  204. Hi miss Nora.ask ko lang po,naadmit po kahapon anak ko 2 Yrs old thypoid fever result.nagtanong po ako sa hospital ng maaring coverage ng Phil health sa ganitong case,ang sabi po eh 10000.ask ko lang po 4days confinement din po ba para macover ng philhealth?14000 po nakita ko na maaring macover tama po ba, in case lang po na 10,000 ang ideduct ng hospital anu po ang dapat gawin?salamat po

  205. Gudday, ask ko lng po if mgagamit po b ang philhealth if nahospitalize khit bgo p lng nghuhulog?

  206. Hi! Are these rates also applicable to private hosp? Thanks

  207. Thanks a lot.

  208. Hi Karen Joy, siguro para makatipid, puede naman sa ward na lang, kasi sa operating room din naman siya nate-treat, para lang mapababa yong bill. Ang bill kasi depende rin sa room. Mas mura ang mga hospital costs kapag nasa ward ang patient. Ang Philhealth’s coverage naman ay pareho lang, ke nasa ward o nasa semi-private ang patient. Merong Z benefit ang certain orthopedic implants; tanungin nio sa doctor o sa hospital kung puede sa case ng papa mo.

  209. Hi Mia, coverage for Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C is 12,900 (6,300 for PF and 6,600 for hospital expense). Covered naman siguro kasi yong biopsy is for diagnosis and polypectomy is for treatment. Pero ask mo rin yong hospital kasi the same part of the body is involved.

  210. Hi Mss. Nora, tanong ko lang po kung magkano po case rate package ng hyteroscopic-guided polypectomy? Makakaavail pa bo ba ako sa package kahit nakapag avail na ako ng 11k last month for biopsy? Thanks in advance.

  211. Hi john kenneth, coverage for newborn sepsis is 11,700 (3,510 for PF and 8,190 for hospital costs), For perinatal/congenital pneumonia, it’s 12,700 (3,810 for PF and 8890 for hospital costs). If it’s diagnosed as moderate pneumonia, it’s 15k; it’s 32k for high-risk pneumonia, but I think these are for adults, as the causes listed are usually experienced by adults. But sad to say, isa lang ang coverage na ibibigay, usually yong higher. I hope your baby gets well quickly.

  212. hai im john keneth my baby was born premature 27weeks sya at nasa NICU…and dependent ko po cya sa philheath and na diagnose po xa nang neonatal sepsis and pneumonia ..mgkano po bah ang case rate due to his condition…

  213. Hi Ms nOra, Ask ko lang po. Yung papa ngkaroon ng vehicular accident. Kelangan dw operahan at lagyan ng stainless yung paa nya. Ano po ang at magkano po ang maccover ng philhealth dito. Government hospital po cya naka confine. Cover din po ba kung mag avail ng semi private room? Thanks.

  214. Hi Abigail, yes, covered siya as your dependent. I hope nag-file ka na ng another Philhealth claim form for your baby. Ang coverage for newborn sepsis is 11,700 (3,510 for PF and 8,190 for hospital expenses)

  215. hi po magandang araw. Nais ko lang po itanong at malaman kasi po ako po ay Nanganak noong August 30,2016 at ang aking anak ay nakaconfine hanggang ngayon sa NICU. Tanong ko lang po kung macocovered po ba ang aking anak since may philhealth po ako at inilagay ko po sya as dependent dun sa form na binigay ng hospital? At magkano po b ang macocovered kung ang diagnosis po ay BACTERIAL SEPSIS OF A NEW BORN?

    Sana po ay inyong masagot ang aking katanungan.

    Maraming salamat po.

  216. Hi Jessa, how much was your total bill? PF and hospital expenses? Coverage for appendectomy is 24,000 (14,400 pesos for hospital expenses and 9,600 pesos for PF). Ang practice ng HMO is they pay the balance after Philhealth is deducted. Kung 14k ang nadeduct, your HMO will pay the balance, up to 150k lang. Kung kulang pa rin yong 150k, you pay the kulang.
    Meron namang HMO na alam nila na ang coverage ng appendectomy is 24k, so ang gagawin nila, total bill minus 24k, then babayaran nila yong balance. Halimbawa nagkasya naman yong 150k, so ok lang sa kanila, at ikaw na ang magbayad doon sa 10k na hindi deducted sa bill. You can refund this from Makati Med. Ask them why the PF portion was not deducted.

  217. Hi. Good Afternoon! I had my laparoscopic appendectomy procedure sa Makati Medical Center, pero ang na cover lang ni Philhealth is 14,000 pesos. Tama po ba yun? Paano po ba ang computation nun kasi may HMO din ako w/c is 150K. First time ko sya magamit and nag exceed ako sa limit. Please help. Thanks.

  218. Hi Jc, there should be a definite diagnosis and treatment. Kapag puro diagnosis lang, o suspected lang yong diagnosis, at walang ginawang treatment, hindi ico-cover ng Philhealth. I hope she’ll get well na.

  219. Hi Armie, wait nio na lang yong benefit payment notice from Philhealth via postal mail para makita nio how much was paid for hospital costs and how much was for PF. Kapag ang ibinayad ng Philhealth for hospital cost ay more than 6,908, meron pa kayong marefund sa hospital. Ano ba ang diagnosis? I’ll check if it’s in the Case Rate list.

  220. Meron po kmi nabili na mga gamit at meds sa labas worth of 2456.00 and ang bill po namin sa hospital na nacover philhealth is 6,908.the package benefit was 11,700.anu po marerefund namin. Thanks po.

  221. Hi. My mom is confined at the hospital for almost a week. Until now there is no specific diagnosis.. ahe underwent duplex scanning for veins and arteries. The doctor said that it is connected to a heart problem. How much will philhealth cover

  222. Hi april, yes, dapat nade-deduct yong Philhealth’s PF coverage from the PF sa hospital bill. Pero usual practice kasi ng mga hospitals or doctors na singilin ng cash yong PF. Ask the hospital kung puede niong i-refund later on yong PF na hindi na-deduct sa bill. You will see how much Philhealth paid the hospital when you receive your benefit payment notice from Philhealth via postal mail.

  223. Hi Rina, emailed you.

  224. Ask ko lang kc my brother ngdialysis cya sa nkti. Kso wla pa kc cya updated mdr kya di pa nagamit philhealth. He just came back from saudi. Sa monday dialysis ulit cya pro malamang wla pa dn mdr dahil weekend na. Ask ko pwede pba cya mkpagrefund pag nkakuha na cya mdr nya?
    Favor can u also send ur answer via my email? Tnx a lot

  225. hello po ask q lang po kung ung pf po ba ng doctor ay nadi discount ng philhealth? binayaran po kc nmin ng 8500 ung pf ng doctor neonatal pneumonia po ang final diagnose sa anak q.. slamat po

  226. Hi violeta, coverage for neuroplasty of major peripheral nerve, arm or leg or brachial plexus, or suture of brachial plexus is 20,980 (10,080 for PF and
    10,900 for the hospital).

  227. Ask ko lng po ano pong case rate sa philhealth ang brachial plexus pa opera po kasi ang asawa ko gusto ko lang po malaman nasa 60,000 po kasi kailangan nmin

  228. Hi erick, kung 2 days lang, mga quick surgery. Yong ibang illnesses, usually more than 2 days din naco-confine. although walang minimum na 4 days. Hindi lang naman pneumonia yong strict sila; pati dengue, asthma, diarrhea, UTI. Merong requirements like blood count, treatment used, etc. Although I’ve just read that Duterte has instructed something about this rule in Davao due to lack of hospital space.

  229. anong sakit po b ng bata ang cover ng philheath na 2 days na naconfine lang?

  230. Hi Armie, meron ba kayong biniling meds and supplies sa labas ng hospital? Puede ninyo itong ma-refund (partial or full) kung hindi lahat nagamit ang coverage sa gastusin sa hospital. Wait for the benefit payment notice from Philhealth. Pero kung wala kayong nabili sa labas, wala na kayong mare-refund, kasi wala naman kayong nagasto sa loob o sa labas — meaning nasagot na ng Philhealth lahat.

  231. Hi erick, ang alam ko ang Philhealth policy is covered lang ang pneumonia kapag at least 4 days na na-confine. 15k ang coverage ng pneumonia 1.

  232. Good Day! Ask ko lang po na admit anak ko kahapon lang Aug. 26 ng hapon..gusto ko na po sana syang ilabas ng ospital bukas Aug. 28.findings daw po ay pneumonia sabi ng pedia..macover po ba ng philhealth kahit 2days lang na admit at magkno po charge ng philhealth?

  233. Hi po ask q lang po anu ano po marerefund namin sa philhealth my son was hospitalized last august 17,2016 and diagnosed as blood sepsis.wala po kami binayaran hospital bill dahil nacover po cia ng philhealth q.

  234. Thank you po Ms. Nora! Itatanong ko ndn po sa billing pra po ms mging clear dn smin.. Salamat po ult!

  235. Hi glenn, sad to say, kapag more than one procedures or illnesses within the same confinement, isa lang ang kino-cover ng Philhealth, usually yong mas expensive. Ang exceptions lang dito ay yong dialysis, chemo and other surgeries na puedeng second-case rate. Wala sa second-case rate list yong cystectomy at appendectomy.
    Yong whether indigent or employed, pareho-pareho lang ang benefit, kahit anong member category, ke dependent or OFW or non-working wife. Kung yong claim form at MDF ng spouse nio ay employed ang category niya at pumirma ang employer sa claim form at nagbigay kayo ng employer’s cert of Philhealth premium contributions, dapat employed ang category niya. Para sure and clear, puede kayong magtanong sa billing kung bakit isang Philhealth deduction lang. Dapat naman ma-explain nila.

  236. Hi Ms. Nora! chineck ko ung hospital bill, 23300 ung nacover ng philhealth.. sa pgkakaalam ko un ay pra dun sa cystectomy tama po ba?kasi nga po my appendectomy pa sya listed dn nmn dun sa medical abstract.. pa help nmn po ano dpat nmin gwin.. my mrerefund pa po ba kmi? thanks sa mgging responce!

  237. Good pm po! Nahospitalize po asawa ko (cystectomy and appendectomy) kaya lang po tingin ko medyo maliit yung philhealth deduction nya about 23k po.. nagtataka ako bakit classified sya as indigent even though employed sya at working for 8 yrs.. malaki naging hospital bill nag range ng mga 170-180k.. may mali po ba don? thanks!

  238. Hi jenny, ang total cost ay depende yan sa OB surgeon at sa hospital. Sorry wala akong estimate. Magtanung-tanong ka sa mga hindi expensive na hospitals. Yong OB na kausap mo, puede mong tanungin magkano po cash out ko if I use Philhealth? Philhealth coverage for ovarian cyst removal: 23,300 pesos ang total coverage for cystectomy (12,600 for PF and 10,700 for the hospital)

  239. Hi Rosalina, coverage is 20,980 (10,080 for PF and 10,900 for the hospital)

  240. my niece went salpingectomy. how much would be deducted to her hospital bill

  241. May I ask po kung mgkno ang maggastos for the ovaian cysts removal?? and mgkno po ang covered ng philhealth? thank you

  242. Good day!
    My husband will undergo knee arthroscopy,and it cost alot..may i ask if covered by philhealth and how much?
    thank you so much,ms nora!looking forward for your reply..Godbless!

  243. Hi Chona, sorry I’m not so sure. Yong single period of confinement rule kasi says na kapag “the same illness or procedure” within 90 days, isang confinement lang ang ma-cover. These 2 procedures are different (have different codes), pero parang the same illness, kasi they involve the same organ, the uterus. Pero ask mo pa rin yong hospital para sure, and so you can prepare. I hope you can share later on, if you have time, kung covered, and thanks a lot.

  244. Good Morning Ms. Nora. Ask ko lang po. Nagpa-hysteroscopy myomectomy po ako last July 5, 2016. Tapos nakaschedule ako for hysteretomy ng August 19, 2016. Di pa rin kase tumigil ung bleeding. Nagamit ko na ung Philhealth nung first operation. Me makukuha pa rin ba ako for the hysterectomy operation? Thanks in advance po sa help.

  245. Hi SHIENA, yes, you can use your own Philhealth for this confinement kasi ibang illness naman. And you can use again your Philhealth when you give birth dahil ibang case naman ang child delivery. Ang single period of confinement rule na kung saan isang confinement lang ang puedeng ma-cover ay kung ma-confine ka within 90 days because of THE SAME illness or treatment.
    About using your husband’s Philhealth: You use your Philhealth kasi member ka; hindi ka puedeng dependent at the same time a member.
    At kung halimbawa lang puedeng gamitin ang husband’s Philhealth for THE SAME illness within 90 days, hindi rin ma-cover yong second confinement kasi THE SAME illness pa rin yong patient.


    I’m pregnant po ngayon at 37 weeks po, naconfine po ako nung june 14 ng 2 days dahil po sa nag pre-labor ako. nagamit ko po yung philhealth ko nun. And then, ngayon po need ko ulit ma-confine dahil naman po sa uti as result po ng urinary culture na di daw po makukuha ng oral medication, ask ko lang po kung pwede ko po ba ulit gamitin ang philhealth ko? o pwede ko po kaya gamitin yung sa mister ko kung hindi na po pwede yung sakin. at magagamit ko pa po ba yung sakin pag nanganak na po ako?

  247. Hi Ailene, nagamit mo pa naman sana yong Philhealth mo para sa kanya as your husband. Puede mo siyang dependent. Just update your data at Philhealth with your ID and marriage cert (orig and xerox). Try to get documents from the hospital so you can reimburse directly from Philhealth. Hindi na pinapayagan ang direct filing sa Philhealth, since 2014 pa yata, pero try mo lang kung acceptable yong reason mo. Or puede ring you talk to the hospital na they file your Philhealth claim for you, with your Philhealth docs, and then refund from them kapag nagbayad na ang Philhealth sa kanila.

  248. Na ESWL po husband ko last Aug 2, nagcash napo kmi since na maxout na po un health card nya as my dependent. Makapag reimburse po ba ako? Dti syang member but cancelled un knyang status dhil wla sya work.

  249. Hi dondon, most likely yong 3,500 ay bayad doon sa room, kasi sabi mo ang coverage ng insurance ay regular room, pero dahil naka-family room, you had to pay the difference between the costs of the regular and family rooms. Ask mo na lang yong health insurer nio.
    Ang standard procedure talaga ay i-deduct muna ang Philhealth, kasi usually nasa health insurance policy yan, na hindi nila ico-cover yong Philhealth coverage. Usually yong HMO mismo nire-remind ang patients to file their Philhealth early. Merong ngang mga cases na yong patient na merong HMO (through their children) ay binabayaran yong Philhealth coverage kasi they forgot to pay their Philhealth premiums.
    Sad to say, yong senior citizen discount, alam din ng health insurer yan, so siempre pinapa-deduct muna nila ito bago sila magbayad. Ang argument ng HMO is itong discount for senior citizen ay deduction sa bill, so hindi babayaran ng HMO. Pero ask your HMO para mas clear.

  250. good day po.. need help po ako regarding sa bill ng papa ko. senior citizenna po siya may Philhealth at may life and health insurance pa. noong naospital siya ngkabill siya ng 55,000 at ang nabayaran lng namin ay 3,500. nadeduct na discount senior citizen, Philhealth at yung health insurance nya. kaso ngtaka papa ko nung nalaman may nabayaran ako kasi daw tatlong beses na siya naospital sa kabilang ospital ni piso wala siya nabayaran. nung tiningnan ko yung billing statement unang kinaltas ay ang senior discount tapos ang Philhealth last ang health insurance. pero kung babaliktarin ang proseso unahin ang health insurance ng papa ko na 150,000package lalabas na matitira excess ay ang room accomodation kasi nka family room si papa at regular lng coverage ng insurance nya. siguro tung excess pwd ikaltas doon ang senior discount at Philhealth nya para wala na talaga kami nabayaran baka kasi yunang ginawa ng kabilang ospital kay tatlong beses siyang wlang nabayaran.. Ano po tamang proseso ng pgcompute ng mga ospital sa mga deductions kung senior citizen may Philhealth at health insurance pa po..?

  251. Hi, ask ko lang if philhealth covered laryngitis.and how much po cover ng philhealth. Tnx

  252. Hi Cristine, is your mother-in-law 60 years old or older? Does she have disability, as certified by a doctor? Kasi puede lang siyang dependent if 60 years old or older or has certified disability. But to be sure, ask the hospital’s Philhealth department.

  253. Cristine Capunitan

    hi, my mother in law was admitted at ICU yesterday..she is not a philhealth member..but my husband(he’s son) is a philhealth member..but his mdr is not updated..
    if ever ba na ma update namin mamaya..automatically covered ba yung mother in law ko?..thanks

  254. Hi Betsy, isa lang sa Philhealth nio ang puedeng gamitin. Bring the birth certificate to support the MDR. Some hospitals will require the MDR to be updated, meaning the baby’s name is written in the MDR as dependent, but other hospitals accept birth certificate as supporting document. The coverage for newborn sepsis is 11,700 (3,510 for PF and 8,190 for the hospital).

  255. Hi! Our 2 weeks old baby was readmitted after giving birth to him via c. Section.. it was septicemia due to a raoultella ornithinolytica. Ano pong benefit pwede naming makuha kami pong dalawa ng husband ko ay parehong philhealh members po. Salamat

  256. My 2 weeks old baby was re admit due to septicemia cause by raoultella ornithinolytica. Anong benefit po namin sa philhealth… both me and my husband were philheath members po..

  257. Hi Edralin, sorry po hindi po covered ang outpatient CT scan or MRI, kasi diagnostic procedure siya at outpatient pa. Most cases na covered ay dapat confined at merong diagnosis and treatment na nagawa (except outpatient chemo, radiotherapy, dialysis, day surgeries, TB, and animal bite). Please ask others too para sure na sure

  258. Ask ko lang po kung cover ng philhealth ang ct scan or Mri. Kung sa pilipinas o sa abroad magpapa ct scan or Mri . Covered po ba sya parehas? Please I need the answer.

  259. Hi jenny, sent you an email.

  260. Hi Mark, sorry pero sana before treatment, tinanong mo yong eye doctor kung puede mong gamitin ang Philhealth, so you could have known if he/she was Philhealth-accredited and if the eye clinic was Philhealth-accredited. Philhealth’s policy is it should be the doctor and clinic that will file the claim, and they will deduct Philhealth coverage from the bill. If you like to pursue this, you can visit the clinic and ask what to do so you can avail of your Philhealth benefit. This will only be viable if the clinic is Philhealth-accredited at papayag sila na i-file yong sa yo kahit tapos na ang procedure.
    About the coverage amount, sorry hindi ko ma-pinpoint ang exact procedure na na-perform sa iyo from the long Philhealth list. Walang retinal tear, or focal laser treatment. God bless too

  261. Good morning mrs nora, ako po ay na diagnose ng retinal tear sa mata. At nag undergo ng focal laser treatment. Itatanong ko lang po sana kung magkano ang benefits na maaring ma reimburse sa akin ng philhealth. Maraming salamat po and Godbless.

  262. hello po miss nora. ask ko lang po. ung ko po kase, nakaconfine sa private hospital. nagkarun po sya ng amebic dysentery. wala pong available sa ward at semi private room kya po sa private room sya ngayon. after 3 days po sya madidischarge at 25k po ang original bill nya. aftet philhealth deduction, magiging 23k na lang po. tama po ba na 2k lng ang madeduct thru philhealth? need answer po kse bukas na po ididischarge ang anak ko. thank you po.

  263. Can u give me an idea of how much coverage ang dengue fever? Bakit 2 cases? Base sa readings ko, 10k? 3k for pf then ung 7k hci, bkt gnyan n lang ang hatian?

  264. Grace joy atienza

    Hi po!ask ko lang po kung magkano ang philhealth coverage ng open reduction with internal fixation thank you and god bless po!

  265. Please may i know the Philhealth coverage for PET scan at National Kidney&Transplant Institute? Thank you.

  266. Hi Artney, Philhealth coverage for tonsillectomy is 18,000 (8,400 for PF and 9,600 for hospital cost)

  267. Good day po, ask ko lang po kung cover po ba ng Philhealth ang tonsillectomy? If cover po, magkano po kaya ang coverage nya? Salamat.

  268. Hi joan, sorry wala akong makitang ovary lang ang inaalis. Merong abdominal hysterectomy which is to remove uterus, tubes and ovaries. Coverage is 30k (12k for Pf and 18k for hospital costs). Pag vaginal hysterectomy, coverage is 30,300 (16,800 for pf and 13,500 for hospital costs). Coverage for removal of part of ovary (Wedge resection or bisection of ovary, unilateral or bilateral) is 18,000 (8,400 for pf and 9,600 for hospital costs). Ask na lang your OB or surgeon so you can prepare.

  269. mgkano ba ang maibabawas s hospital bills pag naopeahan ng removal of ovary?philhealth member po ako

  270. how much philhealth coverage sa ovarian cyst removal??

  271. Hi gud day.. ask ko lang if nacocover ng PHILHEALTH ang PET SCAN sa National Kidney and transplant Institute? How about MRI nd CT scan? thnx alot..

  272. Magkanu po ba coverage ng philhealth diagnosis po acute tonsillo pharyngitis.

  273. retchel bulalacao

    thanks po sa reply.

  274. Hi retchel, room sa hospital? Sorry pero most likely hindi puede. Kelangang merong doctor na willing mag-admit sa brother mo, either yong consulting doctor or ER doctor, at dapat meron reason bakit ma-admit. Sa Philhealth naman, covered kapag confined at least 24 hours and then merong diagnosis at merong ginawang treatment. Kung diagnostic procedures lang ang ginawa, hindi ma-cover. So hospitalization na talaga na merong name of illness at treatment na maco-cover, at hindi na lang 1 day or 2 days, mas costly na, at hindi naman lahat covered ng Philhealth. Meron lang fixed na coverage sa specific illness o treatment. For your brother’s MRI, biopsy and CT scan, meron naman palagay ko social services dept ang VSMMC para puede mong kausapin to get a discount. God bless you din.

  275. retchel bulalacao

    hi po. ask ko LNG po.wat if kukuha nlng kmi ng room.kc out patient po bro. ko need niya mag undergo ng Ct scan, MRI at needle biopsy for soft tissue neoplasm in left arm. malayo kc sa anim ang hospital 4hrs. po biyahe. Pag ganyan po b covered n b ng Phil Heath. ct scan 3600 .. biopsy is 1700 MRI scan is 16000. thanks po wait for your reply. god bless u

  276. Hi retchel, sorry, ang alam ko hindi covered ang outpatient MRI and biopsy as diagnostic procedures. Included lang ang mga ito pag confined for treatment, but usually, dahil ang Philhealth coverage ay maliit compared sa total hospital bill, parang hindi rin covered ang mga diagnostic tests like MRI. Ask the hospital. And ask for assistance from your city hall (offices ng councillors). Show doctor’s MRI prescription.

  277. retchel bulalacao

    hi. ask ko po kung cover b ng philhealth ang MRi and biopsy for soft tissue neoplasm. MRI is worth 16thou. what should we do we don’t have enough money for that. after MRI the require next test biopsy. Vicente sotto memorial medical center

  278. retchel bulalacao

    how much will be philhealth coverage on MRI and biopsy for soft tissue neoplasm on her left arm. I need info for this . we need help we don’t have enough money for this procedures. I’m the one shoulder this… my younger brother need to undergo this in Vicente Sotto memorial medical center in cebu.

  279. How much will be the Philhealth Coverage on Ultrasound Liver Biopsy if to be done In-patient. and also the room coverage of philhealth per day? If the patient will be admitted in ST.Lukes for Liver Biopsy procedure how much is the estimated cost of philhealth coverage. Thanks

  280. Hi Jessica, yes, they can use their Philhealth any time from July to Dec. I assume their son is less than 21, unmarried and unemployed.

  281. Good evening!pwde po ba magamit yong phílhealth ng kapatid ko na na stop nila yong contribution for how many yrs and last wednesday june 28 binayaran nila starting april 2016 til sept 2016. Thier son is scheduled for tonsillectomy?

  282. hi how much is the philhealth coverage for colonoscopy?thanks

  283. Hi Shan, if it’s thyroid biopsy (percutaneous core needle), coverage is 8,260 (3,360 for PF and 4,900 for hospital). Coverage for total thyroidectomy is 31,000 (12,400 for PF and 18,600 for hospital cost).

  284. Hi Rosalia, if the procedure is Esophagoscopy (rigid or flexible, with band ligation of esophageal varices), coverage is 14,960 (7,560 for PF and 7,400 for hospital). If the same procedure or treatment or the same illness within 90 days, only one treatment/confinement is covered.

  285. Hi jodelyne, is this the procedure done? coverage for needle biopsy of liver (percutaneous) is 8,020 (2,520 for PF and 5,500 for hospital). If it’s wedge biopsy of liver, coverage is
    18,000 (8,400 for PF and 9,600 for hospital)

  286. Rosalia G. Adonis

    hi can I use philhealth one after the other for endoscopy with RBL, if I’ve used it already for endoscopy procedures? and how much po is the deductions for endoscopy with RBL? thanks po

  287. I have a thyroid problem,I need to undergo for a biopsy?how much is the coverage of philhealth for that biopsy, and for the surgury of my thyroid?Thanks

  288. Hi po. how much po is the coverage if lifetime member, a senior po. Had operation in the liver for biopsy. They saw a cyst/growth in the liver. Tertiary hospital po admitted. thanks

  289. Hi Nes/Agnes, here are coverages for colonoscopy. If outpatient, ask your doctor if it’s covered even if it’s outpatient.

  290. Hi po. Just want to ask po if how much covered ng Phil health s gastro. Need q po magpa whole abdomen or colonoscopy. Thanks po

  291. Hi po.just want to know if how much po ang covered s gastro …need q po mag p whole abdomen or colonoscopy.. Tnx po

  292. Hi Anne, coverage for appendectomy is 24,000 (9,600 for PF and 14,400 for hospital costs). Make sure that the coverage has been deducted from your bill before you make your final payment.

  293. Hi Ms. Nora. My 17 y.o. son will undergo appendectomy at a private hospital here in q.c. How much phil health benefit can we claim for this po. Thank you very much in advance.

  294. How much does philhealth cover for acute lymphocitic leukemia who will undergo chemotherapy? Thank you po..

  295. Hi Jana, coverage for amputation of the leg ranges from 18,000 to 30,300 (hospital cost and PF), depending on where the cut is made. Coverage of amputation of the foot is 23,300 (12,600 for PF and 10,700 for hospital cost). The coverage is the same whether the member is sponsored or employed. I hope you’re in a government hospital so that the hospital cost is more affordable.

  296. hello po, mrs nora, good day, my papa is currently confined due to gangrene. He has diabetes. The doctor said he’ll be operated on to amputate his paa. He’s a member of philhealth categorized: indigent bali sponsored. Will he get a big deduction? how much is covered by philhealth? thanks po

  297. Hi Diana, it’s only 1,260 (840 for PF, 420 for hospital expense). Find a small hospital or clinic offering Philhealth package for circumcision.

  298. Hi Jean, sorry I don’t know the actual costs. 16,800 will cover meds, room, operation, anesthesia, supplies. If the total exceeds 16,800, you pay the rest. The same with the 21k PF. Usually, the PF coverage is not enough for the doctors. Sometimes they specify cash. Talk with the doctor if they have a Philhealth package. The 20% discount for seniors is only applied to certain medicines, not to the whole bill.

  299. Hello po ulit. How much do they normally charge (full amt.)for transurethral microwave thrmotheraphy or TUMT ? Will the total amt. include everything po ba such as prof fee., medications, room,operation, anesthesia? Other than phil health discount coverage which is 37800, will there be an additional discount for seniors that”s 20% ? Thanks po.

  300. Hi! How much is the discount if the surgery is laparotomy bilateral oophorocystectomy with chromotubation? I will be admitted tomorrow, please give me info about this.. thanks so much.

  301. Yellow po how much is philhealth coverage for circumcision operation po?

  302. Hi Jean, coverage for Transurethral destruction of prostate tissue by microwave thermotherapy (Transurethral Microwave Thermotherapy or TUMT) is 37,800 (21,000 for PF and 16,800 for hospital expenses)

  303. Hi po. Magkano po ba ang coverage para sa microwave laser sa prostate?

  304. Hi del, first, he needs to see and talk about the Z package with a kidney doctor at the hospital accredited to offer the Z package for kidney transplant. Only 6 hospitals are accredited: National Kidney and Transplant Institute at East Avenue, QC; UP-PGH Taft Ave., Manila; Vicente Sotto Memorial Med center in Sambag II, Cebu City; Northern Mindanao Med Ctr in Cagayan de Oro City; Souther Philippines Med Ctr in Davao City; Davao Regional Hosp in Tagum, Davao del Norte

  305. how can we avail of the z package. my brother needs a kidney transplant and and treatment for his eye disease. He needs an injection in his right eye once a month for three months and it cost 80,000 pesos per session. Please help.

  306. Hi Lea, usually the notice is sent within a month to 3 months. Were you confined at a government hospital where you bought meds/supplies outside the hospital? Because if you were confined in a private hospital, your Philhealth coverage should have been deducted from your bill before discharge. Or were you referring to a possible PF refund? About another surgery within 90 days from last Philhealth use, yes, the second one can be covered as long as it’s a different illness being treated and you have not consumed your 45-day allowance per year.

  307. Hi Adelyn, sorry I’m not sure. You need to ask the hospital, as most coverages require confinement of at least 24 hours. Coverage for colonoscopy

  308. Hello po. Does Philhealth cover out patient colonoscopy and biopsy po for senior citizens

  309. Hi Joy, yes, if you go to a government hospital and an OB that offers No Balance billing for tubal ligation.

  310. Usually how long does it takes to receive the payment notice of payment in the mail? That’s the only time I can reimburse after I receive the notice, right? And one more question po, I plan to have surgery for my Lipoma. Can I use my philhealth after I’ve just used it? How much is the deduction if ever? Thank you so much!

  311. Hi po If I’d be ligated, will it be full coverage by philhealth?

  312. Hi jham, I don’t know if this is the surgery you’re asking about: Code 33641 — Repair of atrial septal defect, secundum, w/ cardiopulmonary bypass, w/ or w/o patch. Coverage is
    46,500 (25,200 for PF and 21,300 for hospital expenses). Ask your doctor/hospital the total cost so you can prepare. Those who have commented here complained their surgeons preferred cash and did not issue receipts. If the bill is too big, you can ask help from PCSO with assistance from the hospital’s social service dept.

  313. Tanong ko lang po magkano po ang sakop ng phil health sa congenital heart disease,ASD secundum (open heart surgery).

  314. Hi Lea, yes, it’s possible. It will depend on the hospital’s policy, but that PF coverage should have been deducted outright from the bill. Attach the benefit payment notice from Philhealth to your hospital statement, bill and OR. Keep your own copy. You claim from the hospital, as the hospital is the one who will receive money from philhealth

  315. If we can get a receipt from his dr. That we pay 50k for the PF, is it possible that we can still get the 12400 refund from PF?Thanks.

  316. Hi Lea, that’s really really sad. But that’s not unique. That’s the practice of many doctors, based on comments on our blogs. Doctors even ask the patient to pay their 10%-15% tax if the patient insists on getting a receipt. I don’t know how you can refund because you don’t have a receipt to show. You soon will receive a mailed benefit payment notice from Philhealth. See what’s written there, then you can go to the hospital and ask if you can refund that 12,400 but they will ask for the receipt. tell them the doctor didn’t issue a receipt. Of course they know this practice.

  317. My husband had a cholecystectomy. philhealth deduction was 18600 but for the PF, the doctor asked us to pay directly and were not given a receipt. he asked for 50k. For the hospital, the remaining balance was 800, after the philhealth deduction. How can we refund the remaining 12400 from philhealth as we paid the full 50k? Thanks po

  318. Hello po. How much is the coverage for laparoscopic cholecystectomy please?

  319. Hi Anne, Philhealth’s coverage for colonoscopy ranges from 10,500 to 21,930. See Philhealth deduction for colonoscopy

  320. Hi po! How much po is the coverage for endoscopy and colonoscopy? The procedure will take place in a different schedule. Senior citizen po yung patient. thanks!

  321. Hi Ashley, CS coverage is 19,000 (11,400 for hospital and 7,600 for PF). There’s also 1,750 for newborn care for your baby if you filled up another claim form for your baby and they provided covered newborn care. Did your OB tell you that Philhealth coverage was already included in your package? Meaning for example her usual package is 60k, and you paid 41k? 60k minus 19k? You can try emailing to ask about your benefit payment notice.

  322. Hi po. I gave birth on january 23 2016. up to now I haven’t received the letter from philhealth. In the past, I got one. Was their deduction correct? In the previous letter, deduction was 19000 but in my receipt, only 11400 was deducted, plus that one for my baby 7+ I think. Is the one for me and my baby different?

  323. Hi ej, yes. She just needs to go asap to any Philhealth branch with her ID, fill up the registration form and check FOR UPDATING. She gets new MDR and Philhealth card and pays for Apr to June. She can use it starting June. In July, she needs to pay for July to Sep for continued coverage. She can also pay Apr to Sep outright, if she likes.

  324. hi po, my friend was employed before po. But she got sick so she had to resign and wasn’t able to update membership category and stopped paying. Can she update her Philhealth into individual payor then continue paying contributions? Is she still eligible to pay for the contribution even if she’s sick?

  325. Hi Arnold, if it’s transurethral resection of the prostate (TURP), Philhealth coverage is:
    TURP stage 1 — 21,940 (9,240 for PF and 12,700 for hospital costs)
    TURP stage 2 — 21,940 (9,240 for PF and 12,700 for hospital costs)
    If it’s prostatectomy, there are different kinds and higher coverages. will get back later

  326. Hi Zy, only a few diagnostic procedures are covered. Pure mammogram is not covered; it’s covered only if it’s used as mammographic guidance for needle placement, wire localization and other procedures for a lesion. Ask others too

  327. How about the fixed payment for removal of acute prostate?

  328. are there tests covered by philhealth like mammogram? thank u po

  329. Hi po! How much po is the coverage for endoscopy and colonoscopy? The procedure will take place in a different schedule. Senior citizen po yung patient. thanks!

  330. Hi jude, coverage for excision of varicocele or ligation of spermatic veins for varicocele is 12,900 (6,300 for PF; 6,600 for hospital cost). If it’s surgical laparoscopy, or abdominal approach, or with hernia repair, coverage is 14,960 (7,560 for PF; 7,400 for hospital cost)

  331. Hi po! how much is the coverage for varicocelectomy? thanks!

  332. Hi Ei jhei, coverage for tonsillectomy is 18,000 (8,400 for PF and 9,600 for hospital cost)

  333. How much is Philhealth’s coverage for tonsillectomy? Thanks

  334. Hi angie, coverage for single metatarsal toe amputation or interphalangeal joint toe amputation is 12,120 (6,720 for PF; 5,400 for hospital cost). Coverage for metatarsophalangeal joint toe amputation is 18,000 (8,400 for pf and 9,600 for hospital cost).

  335. amputation of toes, how much is the discount?

  336. Hello po,yun surgery for brain tumor,how much po ang coverage ng philhealth?

  337. Hi Suzette, your BTL coverage of 4k should also have been deducted. When multiple procedures are performed, usually only one procedures is covered, but in the case of CS and BTL, BTL is covered as second-rate procedure. If you like, call the hospital and tell them that your BTL should also have been covered. If the hospital filed for both 19k and 4k, these will appear in the benefit payment notice that you will receive from Philhealth through the mail. If Philhealth refunded 23k to the hospital, you can use this notice plus your hospital receipts to ask for a refund of 4k from the hospital.

  338. Hi po!ask ko lng po I give birth for our 2nd child last April 23,2016 and I undergo c.s w/BTL at St.Vincent hospital here in Cebu but the hospital only deducted 19000 for the philhealth..ask ko lng po if cover ba yun BTL sa philhealth,if so?may refund po ba dito sa BTL?ano requirements for refund?

  339. Hi Jeanne, what you’re allowed to pay this April is April to June and the next quarters. This means you have to wait for June to have the operation, as it seems the operation can be delayed. I hope your surgeon and the hospital are Philhealth-accredited. Thanks a lot for appreciating my efforts.

  340. Hi Nora! Thanks for this very helpful article and for dutifully answering questions in your comments section. I’m supposed to have ear surgery this May, but I haven’t paid since 2008, I think. If I pay the minimum three months (March to May), can I still use my Philhealth this May or do I have to settle for a June operation?

  341. Hi Joanna, if he paid Philhealth for Jan to Mar 2016, then he can use Philhealth this April or May. If not paid, and he will pay for Apr to June, he can use Philhealth in June.

  342. Hi. My brother has a torn acl. according to the dr at pgh, he needs an operation to restore. He’s unemployed now. He last worked in 2010, so he has only 5 months of contributions to philhealth. Can he use philhealth for the operation? The cost is a bit high. Thanks

  343. Hi Deceree, the coverage for tonsillectomy is 18,000 (8,400 for PF and 9,600 for hospital cost)

  344. Hi Noemi, the coverage for extracorporeal shock wave lithotripsy (ESWL) is 18,000 (8,400 for PF and 9,600 for hospital costs)

  345. Noemi Gia Balignasay

    Hi po, is shockwave covered?

  346. Hello. Il be undergoing tonsillectomy by nextweek. How much po is philhealth’s coverage for tonsillectomy? It will be at davao adventist hospital. I worked last 2013 and after that I stopped paying philhealth. But started it again as individual payer for 2 quarters now.

  347. Hi Sheila, at least 3 months within the past 5 months plus current month. For example, confinement is this April, the member should have paid at least 3 months within Nov 2015 to Apr 2016.

  348. Sheila Gay Simbulan

    Mrs Nora if ever confinement is needed, how many months should at least paid to cover the confinement??

  349. hello i have a bartholin cyst and im planning to have an operation how much it philhealth coverage thanks

  350. Hi Mabs, there are 4 types of gastric bypass listed, and Philhealth’s coverage ranges from 55,000 to 58,800 only. I emailed you the details. I think it’s also good to ask other hospitals.

  351. Hi! How much is philhealths coverage for gastric bypass. I went to st lukes and inquired about it and the doctor told me that the procedure will cost 700k. I was just wondering how much is philhealths coverage for this procedure. Thanks.

  352. hi, nora how about this case ( Diffuse subarachnoid hemorrhage & ruptured atrial communicating aneurysm w/ hydrocephalus ), how much will be the coverage for this..

  353. Hi mymy, coverage for cholecystectomy (removal of gallbladder) is 31,000 (12,400 for pf and 18,600 for hospital cost)

  354. Hi Eliza, Philhealth’s coverage for CS only is 19k (7,600 for PF and 11,400 for hospital cost). Coverage for hysterectomy after CS is 30k (12k for PF and 18k for hospital cost). Coverage for bilateral tubal ligation is 4k. Ask your OB if 4k can be added to the 19k CS coverage.

  355. Hi Nora,
    I wanted to ask how much coverage from Philhealth I could get for CS+Ligation or possible hysterectomy… We just got married last January29 & my husband already filed it at HR, unfortunately, Renewal of their HMO is every December so I didn’t make the cutoff, so we are solely depending on Philhealth for benefits since I am a housewife & my philh&SSS are not updated. My due should be May22 but it seems like it’s anytime soon… Thanks in advance for your reply

  356. hi! how much is philhealth’s coverage for gallstone operation? thank you

  357. Hi! Just wanna ask if how much yun coverage rate for Macroadenoma operation ( pituitary gland front lobe area) thanks…

  358. Hi april, Philhealth’s coverage is fixed. For thyroidectomy, coverage is 31,000 (12,400 for PF; 18,600 for hospital cost). If with radical neck dissection, coverage is 46,500 (25,200 for PF; 21,300 for hospital cost)

  359. Hi Nora, my sister will be be having thyroidectomy next week. Her husband is a philhealth member for 5 years. We are confused on how philhealth works. how much philhealth can be deduct on her hospital bills? is it based on her husband contribution? thank you god bless

  360. Hi Beth, you’re not allowed to make payments for past quarters and years. This April, pay Philhealth for Apr to June 2016, then you can use it June or July. Pay at Philhealth so you can update your records and get your new MDR. Bring your ID

  361. Hi nora I have been checked by my doctor yesterday .I had a lump in my underarm but he said that this is not cancerous but we need to remove I need to undergo to a minor operation.he asked me if I have philhealth.I have it but it’s not updated my last payment was the year 2011.if I am going to pay 2400 for payment for january to december 2016 can I use it this coming april? Thank u

  362. Hi my father will undergo a stone removal from his bladder. How much will be the philhealth coverage. Thank you.

  363. Hi Richie, so sorry about your daughter’s condition. I’ve looked over the Philhealth case rate list, and I can’t determine the exact term for the lung surgery that she will undergo. I even researched the terms, but I can’t find a match in Philhealth’s list. There’s thoracotomy, with removal of intrapleural foreign body or fibrin deposit — coverage is 38,440 (19,740 for PF and 18,700 for hospital cost). I don’t know. Have you tried PGH? At many hospitals, you can also ask the hospital’s social services department to help you with documents to ask help from PCSO while the bill is not yet fully paid. You can also go to the offices of politicians and governments officials.

  364. Hello my daughter will undergo for a lungs ooeration because of the water inside her lungs is hardened so it needs to be scraped off. how much will be the philhealth coverage? The doctor already told us to prepare 150thou before operation. We don’t have enough for down payment. please give feedbacks thank u

  365. How much din po coverage ng peritonsillar abscess? Thanks

  366. Gudpm po how much po cover ng philhealth for tonsillectomy for my son? Plz thanks po

  367. Hi jhenn, I’m sad that ct scan is not covered by Philhealth. But to be sure, ask the hospital.

  368. My mother will undergo ct scan procedure, is it covered by philhealth?

  369. Hi lerica, the coverage for newborn sepsis is 11,700 (3,510 for PF and 8,190 for hospital costs)

  370. hello my daugther was diagnosed with sepsis neonatum due to her jaundice. How much po is the coverage? she’s my dependent po. thank u

  371. Hi Cecil, usually Philhealth covers only one procedure or illness per confinement; usually the more expensive one. This means coverage will only be for the appendectomy which is 24,000 (9,600 for PF and 14,400 for hospital costs). Ask the billing department

  372. Hi Nora, My daughter undergo operation due to raptured appendix. We are required to stay for 5 days for possibility of infection. May I ask if the surgical coverage is different from confinement plus the medicine required by the hospital for confinement period?

  373. Hi,are you from phic po?you seem to be knowledgeable of the svcs..nacurious lang po ako,please enlighten me.i just received my bpn,underwent heart surgery at pgh last under social svcs kaya curious ako sa system kasi hindi po standard yung billing unlike private patients na indicated ung phic deduction..di ko alam na may share o malaki po pala share ng phic sa hospitalization ko,until today lang nung mareceive ko yung do i check philhealth deductions sa hospitalization ko?or hindi talaga sya mgaappear if under charity?thanks

  374. Hi Mary Ann, sorry no. Your 2014 payments are no longer usable. Pay asap for Jan 2016 to March 2016, so you can use it this March or April. Pay at Philhealth so you can get your MDR. Fill up registration form. Check FOR UPDATING. Bring your ID.

  375. Mary Ann Ancheta-Cubon

    Last March 2014 i stopped working as clinical instructor due to positional vertigo and hypertension. Since then i failed to pay my monthly Philhealth contribution. If iget hospitalized can i still avail of Philhealrh benefits?

  376. Hi if lymphadenitis how much po coverage?

  377. Hi mareneil, the coverage hepatic amoebiasis is 10, 000 (3,000 for PF and 7,000 for hospital cost); for nonhepatic amoebiasis, coverage is is 6,000 (1,800 for PF and 4,200 for hospital cost)

  378. How much po case rate of amoebiasis

  379. Hi Joy, sorry about what you went through, but I hope your child is on fast recovery now. Are your bills already fully paid? Approach the PCSO desk of PGH and ask if they can help you with the documents needed to get assistance from PCSO. You can also go to the offices of VP Binay (Coconut Palace, CCP Pasay) and the offices of Senators (GSIS Bldg, Financial Center, Roxas Blvd) and Congressmen (Batasan, QC). Bring xeroxes of your medical documents and hospital bills, your 4P IDs, barangay certificates. It’s really possible to ask and receive help from these offices, specially now that it’s campaign time.

  380. Hi po, my child was twice operated on at pgh. The doctor is at fmab, so it’s private but we are 4ps member. Is that really how small the discount is? And doctors fee is cash? My child has brain tumor; we lined up at charity, it’s been 1 month and wasn’t yet operated on and their prognosis was 2mos so we were forced to turn to a private doctor. Where can we go for financial help so we can reduce our debt, thanks po

  381. Hi cherry, I can’t find percutaneous endoscopic gastrostomy (PEG) in the list. There’s this procedure: Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube. Coverage is 18,000 (8,400 for PF and 9,600 for hospital cost). There’s also percutaneous placement of gastrostomy tube. Coverage is 8,020 (2,520 PF; 5,500 hospital cost)

  382. after my grandfather stroke, he cannot eat. Doctors recommended PEG insertion which will cost us the endoscopy procedure. he will need to stay in teh hospital for 2 days. what will the philhealth covers

  383. Hi Robin, each illness has a fixed coverage amount, but only one illness will be covered (the one with the biggest cost; but you still pay the balance if the coverage is not enough. Coverage for high-risk pneumonia is 32,000). Dialysis is one of the few procedures that can be covered too as an additional coverage (2,600 per dialysis). Balanced bill is usually done for a patient with only one illness, which means the coverage for that one illness is enough to cover all the costs. Ask the billing department about Philhealth. Ask for discounts at the social services dept. If you have a relative who can go to offices at the Senate or House, or Vice-Pres and ask for help (bring PGH documents, ORs and IDs), it will help.

  384. Hi Nora, my mother is currently confined at PGH due to Pneumonia, Kidney complications and GI bleeding. She is currently has tube ventilator and had dialysis 2 times now. PGH billing department says bill is more than 150K now and that we need to make some payment. She is a senior citizen philhealth member. Does philhealth cover her hospitalization and is PGH allowed to balance bill? Thank you very much for your helpful blog.

  385. Hi danzen, it’s the doctor who can say if you should have D and C. Yes, Philhealth’s coverage is only 11k. Ask your doctor how much you will pay if you use your Philhealth. If you haven’t paid Philhealth for 3 monthly premiums within Sep to Feb, you cannot use Philhealth this February. If you pay Jan to March now, you can use it in March, but it might not be safe to postpone your D and C. Ask your doctor. Ask others too.

  386. Hi danzen, pay Philhealth for Jan to March (600 pesos) at Philhealth, so you can use it for surgery in March. Bring your ID, fill up registration form, check For Updating, then receive your MDR.
    About SSS, you can file for sickness benefit if you paid at least 3 contributions within Oct 2014 to Sep 2015

  387. I I undergo surgery po can I file it with SSS or can I use my philhealth even if I’ve been unemployed for 3 yrs?

  388. Gud pm. Is the DandC okay for 6 months pregnant? Is the 11k rate fixed?

  389. Hi Aldo, Philhealth’s coverage for appendectomy is 24,000 (9,600 for PF; 14,400 for hospital costs). Ask the hospital how much you will pay if you use Philhealth.

  390. My father is a member of PHilhealth scheduled for apendectomy at FEU hospital. How mush would be the total coat of the procedure. Senoir citizen with Philhealth. Thank you so much.

  391. Hi Adam, based on Philhealth’s list:
    Maxillectomy without orbital exenteration: 46,500 (25,200 for PF; 21,300 for hospital costs)
    Maxillectomy with orbital exenteration (en bloc): 53,400 (29,400 for PF and 24,000 for hospital costs)

  392. Hi I’ll have an operation monday total maxillectomy, how much is the coverage?

  393. Rechelle Mae Labrador

    Thank you Miss Nora. Now its clear. Thanks again.

  394. Hi Yan, yes, submit another claim form 1. Write your baby’s name as the patient. You are the Philhealth member (or your husband, if he is the member). The hospital will use their own birth certificate when they file your baby’s claim with Philhealth.

  395. Hi, I had cs po last feb 14. I left my baby at the hospital because she has infection; she’ll stay there for 7 days. Can I use Philhealth for my baby?

  396. Hi Ellen, has your mother consulted a doctor? Did the doctor advise operation? What’s the name of the procedure? If this is naipit na ugat or trapped nerve or nerve entrapment, I can’t see it on Philhealth’s list.

  397. Hi Rechelle, if there were fractures, why was there no treatment? He should have been referred to the Orthopedic hospital if they’re not able to treat your father completely. Philhealth requires a report of medical condition and treatment. There are fixed deductions for various illnesses, medical conditions, treatments or operations. If there’s no diagnosis of medical condition and no treatment, even if x-rays and scan were performed, there’s no Philhealth coverage. So sad to know about this. Ask others too.

  398. Hi good day, will my mother be covered by philhealth if ever she’ll have an operation for veins(ugat) na naipit?

  399. Hi katrina, yes. Total coverage is 18,000 (PF: 8,400 pesos, Hospital Costs: 9,600)

  400. Hi rosemarie, sad to say, CT scan is not covered by Philhealth as a separate procedure. Ask the hospital

  401. Rechelle Mae Labrador

    Thanks for the reply Ms. Nora. On the first day of admission, they filed the papers, the hospital and doctors are Philhealth accredited.The only perform scans and x rays and surround his legs with bandages coz of fractured bones. No operation done. Since he was admitted, is there no philhealth coverage at all? Thank you.

  402. Hi Rechelle, did they file their Philhealth papers before discharge? Is the hospital and doctor Philhealth-accredited? Was any of the conditions or treatments done on your father in the list of covered illnesses or procedures? Or did they perform only scans and xrays? If wound care was performed, there should have been a deduction.

  403. hi good afternoon po. ask ko lang po kung covered ba ng philhealth ang varicose vein surgery? thanks po.

  404. Gd day.My mother is a senior citizen.she is confined in a private hospital.she needs a ct scan biopsy…is this procedure covered by philhealth?the procedure will be done in another hospital since its not available on the hospital where my mother is confined.

  405. covered po ba ng philhealth ang tonsillectomy?

  406. Rechelle Mae Labrador

    Hi. My Parents are both confined in the hospital due to an accident. My father was released after 4 days with no benefits from philhealth. His hospital bill is amounting to 29,000.00. I wanted to seek information why he was not covered by philhealth since their payment is on time and he was admitted at the hospital. thanks for your reply.

  407. Hi joanne, if your son will be operated on at the pay department, and not at the charity department, you can use Philhealth. Coverage is 21k (8400 for PF and 12600 for hospital cost). Talk to the surgeon or to the one in charge of your case. As what usually happens in public hospitals, if supplies/meds are not available, you have to buy them outside the hospital, and then refund your expenses later, so prepare. Have your ORs in the name of your son and keep your receipts.

  408. Hi po if my son gets operated on for luslos or hernia at pgh, will it be covered by Philhealth? and how much po.

  409. Hi Liezl, yes, coverage is 18k (8400 for PF, 9600 for hospital costs)

  410. Hi Angel, yes, 3,000 per session if with linear accelator. 2,000 per session if cobalt radiotherapy only.

  411. Hi avelina, it depends on the OB and the hospital. Might be priced the same as CS. Ask several OBs/hospitals. Might range from 40k to more than 100k.

  412. hi how much po is ovarian cyst removal in private hospital thank u

  413. Hi, 3000 pa din po ba yung cover ng philhealth sa radiotherapy like radioactive iodine? Thanks po

  414. Good pm. Covered po ba ang tonsillectomy? How much is the coverage? Thanks. God bless.

  415. thanks Nora for your entlightment. Can you recommend hospital in Albay or province or Legazpi City . Im from Bicol.. My father is senior and his not high blood but low blood.
    God bless po

  416. Hi Amy, the coverage is 16k per eye. Both eyes can be covered in 2 separate operations. The first step is to find a Philhealth-accredited eye surgeon whose clinic or hospital is accredited with Philhealth. If you’re okay with a generic lens (not branded) and if your father does not require high-blood-pressure monitoring, usually you pay only for the check-ups and tests. I have a post here:

  417. Gud afternoon, how much is coverage for cataract removal? I am the member but my father is my dependent. My father want to be operated in cataract, can we avail the discount in Philhealth. How much would be deducted if in case he ll be operated. thanks.

  418. Hi Ivy, sad to say, Philhealth’s coverage for severe pneumonia is only 32k (22,400 for hospital costs and 9,600 for PF). If you like, you can ask the hospital’s collection department to help you with documents needed to ask help from PCSO.

  419. Gud morning my mom confined she has pneumonia and its already 8 days now. Our bill already cost 85k. How much will be cover it by philhealth?tnx

  420. Hi Filomena, do you mean your husband is not yet qualified for Philhealth’s senior Philhealth program? If not yet, then request a new MDR from Philhealth that includes your husband as your dependent. Bring your ID and marriage certificate. If qualified, his operation should be covered fully since it will be done at a government hospital. But ask the surgeon if the Philhealth coverage is enough. Some pay-department doctors at government hospitals ask for additional PFs.

  421. Gud pm my husband will undergo operation for galstone removal nxt week at government hospital and he is my dependent in my philhealth i am now a senior and my philhealth now is lifetime is he also covered to the package of 31k and we will no longer pay anything in the hospital? Thanks

  422. Hi Charmaine, there are two renal biopsies in the coverage lists:
    1. percutaneous renal biopsy by trocar or needle — 8,020 (2,520 for PF and 5,500 for hospital costs)
    2. renal biopsy by surgical exposure of kidney — 18,000 (8,400 for PF and 9,600 for hospital costs)
    Ask your doctor because I don’t know if it can be availed as outpatient. Doctor and hospital must be Philhealth-accredited

  423. Hello, is renal biopsy covered. If so, how much? How much is covered for doctors fee?

  424. Hi Tizzia, there’s no “paracardiac” in Philhealth’s list, but there are lots of types of high-risk pneumonia — coverage is 32,000 (9,600 for PF; 22,400 for hospital costs)

  425. hi daughter was diagnosed with paracardiac pneumonia. How much yung deduction sa philhealth?

  426. Hi Russell, coverage for TURP stage 1 is 21,940 (9,240 for PF and 12,700 for hospital costs); TURP stage 2 is 21,940 (9,240 for PF and 12,700 for hospital costs). I don’t know if the coverage for 2 stages can both be applied to a one-time complete TURP procedure. Doctor and hospital should both be Philhealth-accredited. Ask your doctor how much will you pay if you use Philhealth.

  427. Hi glenda, the PF of doctors at the pay department of PGH vary. Consult with a doctor and then ask about the things that you need to pay.

  428. Good pm!magkano po madidiskwento ko kapag ako ay maooperahan sa ovary at maliligate na rin private hospital po.salamat.

  429. Hi,i just want to ask about the bone that my husbnd need a surgical how will i need to pay for a doctor in phil.general hospital

  430. Hi, I want to ask how much could be deducted from the doctor’s quote of almost 100k for a TURP surgery in a private hospital?

  431. Hi maribel, the coverage for radiotherapy (radiation Treatment Delivery by Linear accelerator) per session is 3,000. Coverage for multiple myeloma is 13,900 (4170 for PF, 9730 for hospital costs). Ask the hospital about costs.

  432. going to have radiatìon for a plasmacystoma(tumor) of a bone marrow cancer called multiple myeloma. How much bebefit can I get from philhealth? Thank you

  433. good day po.. how much po ang cover ng clinical sepsis?

  434. Hi Grace, it depends on the actual diagnosis. Diabetes coverage ranges from 10,100 to 15,800. The same with kidney, from 8k to 15k. The coverage for most kidney illnesses on the list is 10k. She will get one coverage only (the higher coverage) plus dialysis if she needs it. Ask the hospital’s billing/accounting dept.

  435. Hi Nora, my mother is a senior citizen and admitted in a private hospital because of her kidney/diabetes. How much discount she can get in philhealth?

  436. Hi Glendz, your Philhealth deduction should have been 15,000. After you receive your benefit payment notice from Philhealth and you see that Philhealth paid 15k to the hospital, go back to the hospital with this notice and your hospital bill and OR and request for your refund of 10,000.

  437. I was admitted last week due to pneumonia (moderate risk). my philhealth benefit was only P5,000. Why is that so? So little benefit. Paid a lot to the hospital.

  438. I have typhoid and uti diagnosed in the hospital..can I get the two different benefits for less in my bill?? And how much amount can be deducted respectively…thank you

  439. mother is confined in a private hospital. Diagnosis is pneumonia, heart failure and diabetic, how much would be the philhealth coverage? How much will be deducted on our bill? She’s a senior citizen. Thanks

  440. Hello Ms. Nora. I hope you can help us. My niece is 5 months old diagnosed with dengue, pneumonia and sepsis. May I ask how much will be the Philhealth coverage for those illnesses. Thank you so much.

  441. hi how much cover sa uti

  442. I just wanna know if transsphenoidal surgery is covered by philhealth,and how much will be deducted..i had acromegaly secndary to pituitary tumor and need to have a transsphenoidal surgery

  443. Hi, my baby is 9days old diagnosed with neonatal sepsis due to pneumonia. How much is the coverage for neonatal pneumonia or neonatal sepsis?

  444. Hi Nora hope you can help. My nephew was confined in a private hospital. The diagnosis of the doctor is sepsis. How many percent will be d3ducted to the bill.

  445. Hi Diego, here are the coverages:
    Extracorporeal shock wave lithotripsy (ESWL): 18,000 (8,400 for PF and 9,600 for hospital costs)
    Percutaneous nephrostolithotomy or pyelostolithotomy: 30,300 (16,800 for PF and 13,500 for hospital costs)
    The same coverage for nephrolithotomy (secondary surgical operation for calculus)
    Nephrolithotomy (removal of calculus): 27,120 (15,120 for PF and 12,000 for hospital costs)
    Yes, the coverage is allocated for PF and for hospital costs.

  446. Hello, my mother in-law had a surgery operation for kidney stone removal. How much is the philhealth coverage and are the professional fee and operation procedure fee different?

  447. Hi Annabelle, the coverage for newborn sepsis is 11,700 (3,510 for PF and 8,190 for hospital cost). To be sure, ask the hospital. Have you submitted your Philhealth papers to the hospital?

  448. Hello Nora. My Newborn daughter is ABO incompatible and is having sepsis because of her yellowish discoloration of sclerae. unfortunately we were not able to bring her to the hospital immediately only after 15 days since birth. she is confined in a primary hospital. I would like to know how much we can avail of the package for us to budget our bill. Thank you. Belle

  449. Hi Orly, yes, because pneumonia and bronchitis/acute tonsillitis are different illnesses.

  450. son was confined last oct.with diagnosis of pneumonia.philhealth coverage was 15000. This nov 27 he was admitted again and diagnose with brochitis and accute tonsilitis. Can i get another coverage in philhealth for this sickness?

  451. Hi Jonah, the coverage for cholecystectomy (gall bladder removal) is 31,000 pesos (12,400 for PF; 18,600 for hospital cost)

  452. Hi xeli, the Z package for colorectal cancer has just been approved this November, and Z packages require pre-authorization from Philhealth before treatment is started. You should request for pre-authorization for Z package coverage. Your sister in law will need to sign the request form. Ask your doctor or the billing department.

  453. my sister-in-law is now confined at PGH due to colorectal ca.we were told abt the z benefit that will cover her treatments,hospitalization,meds,lab,etc.,but why does the hosp charge deposits every now and then?pls enlighten us on this.she is advised surgery as soon as her lungs are stable because she has asthma right now.stage 111 po ang ca nya.

  454. How much is the coverage/package for Laparoscopy?
    Gall bladder removal?


  455. Hi Ms Nora.accdng s bpn ang bill ng ank q 35k plus s hospital.nagpay ng 38k ng p.hlth mployee ng ospital since nka leave un mag ayos ng papel w8 kami inform if ma refund un 3k excess n binayaran ng p.hlth s ospital ndi b refundable un ng member at nid p nila i check.after 9mos kundi p ko nagpakuha ng bpn s office ng p.hlth wala kmi n recieve s mail.nid magbayad on time ang member.service nmn ng refund ay ganynn kabagal.maraming salamat po s oras nu.godbless

  456. Hi Mylene, the coverage for tonsillectomy is 18,000 pesos (8400 for PF and 9600 for hospital costs)

  457. Good afternoon. May I ask of the benefit package for tonsillectomy? Thanks much.

  458. Hi Kiray, sad to say, you’ll get only one coverage, the costlier one. There are cases that can be covered as second case-rate, but these are procedures like dialysis or chemo.

  459. Hi I was admitted with diagnosis of pneumonia and ashma. Will I will able to claim both 15k and 9k?

  460. Hi BJ, based on those who have commented on our health blog, the cost ranges from 100k to 250k or more. Find a more affordable hospital. Or find a surgeon who works at the pay department of a government hospital, and ask about his/her cost package with Philhealth already considered.

  461. Hi AngeLee, sorry I think it’s not covered. I can’t see in the list. MRI is primarily a diagnostic procedure, so most likely it’s not covered. Ask the hospital.

  462. Hello, how much will a Thyroidectomy usually cost?

  463. hi. my doctor recommended a lumbo sacral MRI. is it covered by Philhealth?

  464. Hi Nora, I’m diagnosed with ovarian neoplasm and my doctor advised me to have my left ovary and my uterus removed. How much will it cost me? I’m a philhealth member also. Thank you

  465. Hi Thomas, were you advised about what treatment to have? The coverage amount depends on the procedure that will be done. Since Philhealth coverage amounts are fixed, it’s advisable to have the treatment done at a more affordable hospital. If you’re a Makati resident, I think Makati has a special health card for its residents. If your doctor advises you to undergo a certain procedure, then you can ask several hospitals for their rates for that certain procedure. You can also ask for a second opinion about the advised treatment.

  466. I am a senior citizen with senior id and also lifetime member with Philhealth.
    I went for scanning and found out I have a small swelling on my right kidney
    Kindly advise what I should do and how much I have to pay. Also which hospital I should go. I stay at fort bonifacio ( st Luke global city)
    Kindly advise

  467. Hi Kathy, coverage for sepsis due to streptococcus is 32,000. Ask the billing department so you can prepare.

  468. Hi Ann, 4,500 is allocated for the doctor. It’s sad but based on comments on our blogs, some doctors want cash, so they want patients to pay cash. Ask your hospital why the 4,500 PF coverage was not used to pay the doctor. Ask them if you can refund the 4,500 after you receive the benefit payment notice from Philhealth, and if not, ask them where the 4,500 will go — will it go to the doctor as additional PF?

  469. My son was hospitalized fir 7 days. The diagnosis was pnuemonia 1 mr. Upon discharge, the deduction from our bill was just 10,500. I still paid total amount of 6200. Akala q po ba 15,000 ang coverage ng pneumonia 1? Bkit po kya 10500 lng ang deduction?

  470. Hi. My 92-yr old lolo is currently confined at a private hospital. His initial diagnosis is sepsis complicated by UTI. He’s been there for 3 nights alreadt. Would you know how much Philhealth will cover on his bill? Thank you.

  471. mgkno cover ng uti

  472. Hi Evangeline, there are nearly 100 laparoscopy procedures on the list. What part of the body is being treated?

  473. My sister is 88 years old she will have laproscopic surgery I hope I spell it right but anyway the cost is 150,00 pesos I wanna know how much they will pay and she will stay 3 days in the hospital.

  474. Hi Princess, you need to consult with a doctor and have it examined at a government hospital. You might need to pay for the lab exam, but you can ask for discount at the social service dept. If thyroidectomy is advised, ask if it can be fully covered by philhealth. At many public hospitals, the patient needs to buy some meds/supplies outside the hospital, and will request for refund later on.

  475. Hi good day i have goiter, already a bit big. I have not had lab exam.I’m willing to go on a surgery in case. if at a government hospital, is all covered? Do I have to pay something for thyroidectomy?

  476. Hi kevin, no more from Philhealth because you already got your coverage; Philhealth already paid for your operation. That BPN is useful if you paid the hospital, or if you bought medicines outside the hospital.

  477. hi po. Can I get something from philhealth even if I did not pay anything to the hospital. I received a BPN. I had operation for appendicitis.

  478. Hi mark, Philhealth’s coverage is only a small portion of the cost. Sorry I can’t give the exact amount because I can’t find this exact diagnosis on the list. There are lots in the list, ranging from 30k to 50k. It’s better if you ask the hospital’s billing department.

  479. Cardiac Cathetherization PDA Closure operation costs 285,000. how much is philhealth coverage?

  480. Hi cecille, yes, your sister can use Philhealth for her kidney problem, but the coverage is only around between 10k and 15k, depending on the specific diagnosis. Hemodialysis is covered — 90 hemodialysis per year at 2,500 pesos each.

  481. good pm po can my sister use her for her lupus. She’s currently confined at the national kidney hospital for her kidney problem. and for dialysis too, can she use Philhealth for this? How much is the coverage? thanks and god bless po.

  482. Hi Mariel, sad to say, most outpatient laboratory procedures like scans and blood tests are not covered. I hope you find a hospital lab with cheaper rates.

  483. Thank you Nora for your advice! God Bless and more power!

  484. I’ve had goiter for 15 years. im 32 yrs old po, but my goiter is only small. Can I use philhealth for laborat0ries? I’ve been asking questions ever since about what to do. tnx

  485. Hi Ella, if your employer paid your premium for August and Sep and will pay for Oct, your daughter can use your Philhealth in Nov. This is because your employer can then certify that you have paid at least 3 contributions within 6 months prior to treatment. If your employer can pay for Oct immediately and can give the 3-month-payment certification, ask the hospital if you can use Philhealth this Oct.

  486. Hi, good day! I was a contractor,individual payee for 1 year July 2014-Aug 2015. I didn’t pay for my contribution during those time. Now I am a full time employee, started in mid-August. My employer is sure paying my contribution for Aug and Sep of this year. My daughter will be scheduled for a cyst removal operation. When is the best time to schedule the operation, since it is not an emergency case, to avail Philhealth benefits? Is there any way I can cover my missed payments? Thanks in advance.

  487. Hi, Tess, we emailed you the list.

  488. hello ma’am,can you send me in my email the coverage list of pneumonia?Because my youngest daughter is now 4 days in hosp and i would like to know how much we will pay for the hosp bill.thank u so much.

  489. Hi.I would like to ask how much would Philhealth deduction to PCNL procedure. Iam undergoing the said procedure on October 9, 2015. It is kidney stone type of pprocedure.Thank you.

  490. Thanks for the help Nora. However, my mother’s main treatment would be radiation therapy (outpatient) which would be combined with chemotherapy (pills). She would be treated for 5 consecutive weeks (25 sessions). I looked it up and as I understand it, Philhealth could cover up to 45 sessions of outpatient radiation therapy per year. Does it mean that Philhealth could cover the entire duration of her treatment? Thanks a lot for the help. She’s diagnosed with rectal cancer by the way.

  491. Hi Jaypee, sorry that it’s the other way around, as Philhealth coverage is also limited. It has a fixed rate for every covered treatment. Philhealth will first be deducted from your bill, and then HMO will pay the rest. For chemo administration (code 9648), the coverage is 7,280 (1,680 for pf, 5600 hospital cost). There’s a certain no. of chemos that a member can avail of per year (most likely 22). Chemo can be claimed in addition to another covered treatment/illness. If it’s a breast or cervical cancer diagnosis, research if your mother’s case can qualify for Case Type Z coverage.

  492. hi, ask ko lang po kung magkano ang coverage ng salpingo-oophorectomy? If laparoscopy, covered din po ba? Salamat po

  493. Hi, My mother is to start her chemoradiation therapy soon and I was wondering how much philhealth could cover for our expenses. She has an HMO since she is my dependent but the HMO’s coverage is just limited. I was hoping that philhealth could cover the majority of the remaining expenses. Thank you.

  494. Hi Chris, do you mean your hospital bill showed only 10,500 Philhealth deduction? The 15k coverage is allotted as 10,500 for hospital cost and 4,500 for PF. Ask the hospital why 4,500 was not deducted from the PF. Some physicians get the PF coverage as additional to their cash PF.

  495. Ron Ron L. De Los Reyes

    Hello nora, i was not able to use my philhealth benefits nor reimburse my expenses based of the full case rate system of my daughter who suffered pneumonia. The hospital said that there is a minimum number of days of confinement of 4 days before i can avail of my benefits. Is this true? Thank you.

  496. Hello Ms, I was admitted with moderate Pneumonia, but Phil health only covered 10500, wherein the stated coverage amount should be 15000. Pwede ko ba ma reimburse yun, and what are the documents that I need to process it.

  497. Hi Ella, yes, there are several types of laparoscopy covered by Philhealth. One is surgical laparoscopy for enterolysis (freeing of intestinal adhesion); coverage is 18k.

  498. Is the laparoscopy covered by Philhealth? Thanks.

  499. The doctor said 12k with Philhealth already deducted. It’s private po. endoscopy po in the stomach

  500. Hi Alma, I checked the list and there are several kinds of endoscopy covered: upper gastrointestinal endoscopy, small intestinal, biliary, renal, ureteral, neuro. Coverage ranges from 8,260 to 23,300 depending on the kind or type. First, find a doctor willing to perform the process with your mother using Philhealth and ask if it will be fully covered by Philhealth, and if not, your estimate share of the cost.

  501. Hi anna, if it’s code 44180: surgical laparoscopy, enterolysis (freeing of intestinal adhesion), coverage is 18k (8400 for PF and 9600 for hospital cost). The senior’s 20% discount is only applied to certain medicines and certain services. It’s not applied to the whole bill. I hope she already got her senior-citizen coverage ID from Philhealth.

  502. My mother plans to have endoscopy. Is this covered by phihealth if outpatient? What’s the process?

  503. Hi Clang, if your diagnosis and treatment is for asthma, then your coverage will only be for asthma (9k). There’s no additional discount for pregnancy. Ask also the hospital’s billing dept.

  504. Hi Tina, the coverage for newborn jaundice is 7,400; it’s 11,700 for newborn sepsis. If the doctor wrote sepsis as primary diagnosis, and if Philhealth pays the hospital 11,700, then you can request for refund later from the hospital. Keep your ORs and all hospital docs. Wait for your benefit payment notice from Philhealth so you can see how much Philhealth paid to the hospital. If Philhealth paid only 7,400 or 7,800 to the hospital, then it means you’ve already received your full coverage.

  505. Hi Jinki, yes, your D&C will be covered. It’s normal delivery that’s being counted for the limit of 4 deliveries. Coverage is 11k. If clinic, make sure that it’s licensed to do D&C. Both hospital/clinic and OB should be Philhealth-accredited.

  506. Hi! I would like to ask if D&C surgical procedure will still be covered even if this is my 4th pregnancy. Thank you!

  507. How much is the philhealth coverage of jaundice and sepsis of a two months old baby?

  508. My baby was admitted due to jaundice secondary to sepsis. All my billing 7800k was covered by philhealth. Other medicines are bought outside the hospital.Is there a refund to be claim on philhealth in the future? Thanks a lot.

  509. Hi may I ask. I’m confined because of my asthma attack. I’m pregnant. Can I get additional discount because of I’m pregnant aside from my 9k discount for asthma case? Pls reply asap thank

  510. How much is the coverage for laparoscopic surgery for adhesion, for my mother who’s senior citizen. Can she claim philhealth and can she avail of 20 percent seniors discount?

  511. Hi Homer, sad to say, I checked the list for second-rate cases, and neither condition can be covered as second-rate case, so only one will be covered – the one with higher treatment cost. Ask the hospital’s billing department.

  512. My child has pneumonia and typhoid fever. Can I avail of both the case rate packages or one only? I’m an active philhealth member and my child is my dependent.

  513. Hi Jocelyn, sad to say, Philhealth does not yet reimburse outpatient medicines.

  514. good day po. Can I reimburse from Philheath the cost of my diabetic medicines? I’m on a tight budget. I have receipts. thanks

  515. Hi Helen, you can ask the hospital why 2k was not deducted from the PF you paid. Usually they tell you, the 2k is an addition to the OB’s PF. Or they might say you can refund from them after you receive your benefit payment notice from Philhealth.

  516. Thanks ms, yes 3k appears on the deduction but there’s no deduction of the Drs PF. What should I do on that? Can I still claim my deduction? Thanks ms

  517. Hi Helen Mae, if you deliver at a hospital, the coverage is 5k (3k for hospital costs and 2k for PF). That’s why only 3k was deducted from your hospital costs. There’s also 1,750 for newborn care. Maybe only 1,250 was deducted because they didn’t have the other newborn procedure or the cost of a certain procedure was higher than Philhealth’s coverage.

  518. hi ms god day po! I would like to know and inquire if I got the full deduction of my 1st born baby in normal delivery? Base on the billing I received after my husband paid, we found out that 3,000pesos for me Mother & 1,250pesos for our baby is credit thru PhilHealth. Now my understanding is 6,500pesos is fixed rate for normal delivery. Is the accommodation room is already covered on that 3,000pesos or not? Pls. Help us to understand. Thanks po

  519. Hi elaine joy, yes, cyst surgery is covered but you need to find a surgeon and a hospital which are both Philhealth-accredited. And ask the surgeon about using Philhealth. Mammography is an outpatient diagnostic procedure so it’s most likely not covered. I can’t find it in the list of Case Rates. Ask others too

  520. hai po good morning may i ask if cyst surgery and mammography test are covered by philhealth? thanks po

  521. Hi Nicky, no, the 20% is only applied to certain medicines and fees. Not all hospital fees are discounted by 20%.

  522. Hi nora, thanks for ur reply. After the 31k philhealth deduction, is there a discount for senior citizen also? So after 31k, will the patient be entitled to another 20% discount for seniorcitizen for the remaining balance? Thanks

  523. Hi may, it would depend on the severity and cause of pneumonia. Sorry I don’t know the specific symptoms. What I know is that the hospital needs to send the x-rays or other diagnostic results to Philhealth. I’ll email you the coverage list for pneumonia.

  524. Hi Nicky, if it’s cholecystectomy, the coverage is 31k (12,400 for PF and 18,600 for hospital costs and meds). Since this is a public hospital, prepare money because you might be required to buy meds outside the hospital.

  525. Hi Ceya, yes, it’s covered, but you should make sure that the surgeon and hospital/clinic are both Philhealth-accredited and that the surgeon knows you’re using Philhealth

  526. good am. my father is in hospital due to pneumonia..may I know what is different with high risk and moderate risk pneumonia?

  527. Hi, how much can philhealth deduct for gallbladder stone operation to be done at NKTI? Thanks for your help.

  528. hi, is cyst surgery covered by philhealth? my dad has cyst and he is already a senior citizen, tomorrow would be the surgery… thankz

  529. Hi veronica, when you said SOA, do you mean the benefit payment notice from Philhealth? If yes, the amount paid by Philhealth to the hospital should be the amount that was deducted from your bill (Philhealth deduction). Coverage for pneumonia 1 is 15k; pneumonia 2 is 32k. Ask the hospital for refund, if the deduction was less. Keep copies of your ORs and bills.

  530. hello po how do i know if I got my full benefits, base on my daughter’s case it was severe pneumonia so i thought I did not have to pay the bill. After I received SoA, the coverage on the SOA was different

  531. Hi rosario, if this is chemotherapy (RVS 96408), you get 22 cycles. One cycle of chemotherapy is equivalent to 2 days deduction from the 45-day benefit allowance per calendar year. If this has increased, just like hemodialysis, I’ll get back to you. Or ask others too

  532. good pm under philhealth, how many times can we use chemotherapy within a year?

  533. Hi sam, no more Philhealth reimbursement because your Philhealth benefit was already used to pay part of your hospital bill. HMOs require the full Philhealth benefit to be deducted first, and then HMOs pay what’s not covered by Philhealth, up to your HMO’s maximum limit.

  534. Hi po, can I get any reimbursement from Philhealth for in-patient treatment for my child who was admitted for 4 days for cellulitis. We did not pay anything. Medicard and philhealth paid around 30k bill. thanks po

  535. Hi Lilian, sad to say, outpatient MRI is not covered. Most diagnostic procedures are not covered. Even if confined, diagnostic procedures are usually not covered because of other hospital costs. Ask others too.

  536. Gud am po. I was advised to have abdominal mri. Is this covered by philhealth? Not enough budget for it. thanks po.

  537. Hi Sylvia, sad to say, outpatient medicines are not covered. But there’s the TB-DOTS program (4,000 pesos worth of meds, etc.) — you can avail of this by consulting at a local health unit, or a government hospital with this program. About pneumonia, this is covered only if confined. There’s also the 90-day single confinement rule, which basically says that only one pneumonia confinement (the same illness) for the same patient is covered within 90 days.

  538. Hi I’m Sylvia, are meds for tb and pneumonia covered by philhealth? my mother is 85 yrs old and we came to know only a while ago that she has ptb. she needs a lot of meds and there are even vials that need to be injected 3x a week to treat pneumonia.

  539. Hi Demri, yes, coverage for excision of varicocele or ligation of spermatic veins for varicocele is either 12,900 (6300 PF, 6600 hospital) or 14,960 (7560 PF, 7400 hospital)

  540. Hi! Is surgery for varicocele covered by Philhealth? Thanks

  541. Hi Divina, hysterectomy is the process of removing the uterus. Philhealth’s coverage for total abdominal hysterectomy is 30k (12k for hospital costs and 18k for PF). Find a Philhealth-accredited OB at a not-so-expensive hospital and ask how much you’re going to pay if you’ll use Philhealth. Ask around; you might know someone who already had hysterectomy. God bless too

  542. Hi Ms. Nora

    good day po, isa po akong OFW,nagbayad ako ng aking contribution sa Philihealth last February ng taong ito, ang problema ko po ay lagi po akong dinudugo at halos isang buwan kung minsan ay higit pa, dahilan po ng pagbaba ng aking HGB na ngayon po ay 7 na lang, nagpa raspa na rin ako pero bumalik pa rin ang ganong condition ko, nagpa blood transfuse na rin ako dahil bumaba ng 6.2 ang hgb ko that was 2014, ngayon po ang advice sa akin ng doctor ay kailangan ng tanggalin ang akin uterus, yon na lang daw po ang pinakamabisang paraan para matigil na ang aking pagdurugo, kaya po uuwi ako ngayong week na ito. ang tanong ko po ay, covered po ba ito ng philhealth? magkano po kung sakali ang magagastos ko kasama na po ang blodd transfuse dahil kailangan yon bago ako maoperahan at ano po ang mga kailangang requirments..
    maraming salamat po.. God bless you and more power..


  543. Hi Ricky, it should be the hospital that will file with Philhealth, but if the reason for CF1 delay is valid, like due to a discharge on a Saturday or Sunday, Philhealth considers a filing from the member. But you need to get claim papers from the hospital so you can file directly with Philhealth. Include your hospital bill and payment OR. Additionally, I see only 2 dehydration coverages in Philhealth’s list: dehydration of newborn and maternity-related dehydration, so I’m not sure if your daughter’s diagnosis is covered. You will know when you ask the hospital for claim papers.

  544. Hi Ivy, yes, tonsillectomy is covered. Coverage is 18k pesos. Find an accredited surgeon in an accredited hospital.

  545. Hi Ms.Nora, My daughter confine for dehydration for 1 day I would like to ask if I should refund my hospital bill which I pay in cash P5,800.00 my Philhealth was delayed of one day release due to signatories. I have no option to wait my daughter has an exam in school that day we discharge. Thanks,

  546. Hi Ms. Nora, I would like to ask if tonsillectomy is covered by Philhealth.

  547. Hi Benjamin, yes, it’s covered but it’s most likely you’re going to pay a bigger part of the cost. Here’s a list of Philhealth-accredited dentists

  548. Hi Betj, if the main diagnosis for his picu confinement is not neonatal sepsis, meaning it’s not the same as the first diagnosis just after he was born, then you can use again your Philhealth. It’s been 2 weeks, you can now go to the billing department and ask about your billing and Philhealth deduction

  549. Benjamin R. Alimorong

    need advice. my live in partner is an OFW in singapore. there’s cyst in her gums. the dentist advised her to have surgery. will this be covered by philhealth if she’s sent home to have the surgery? tnx

  550. Hi, ms Nora.I gave birth last July 27. my child was diagnosed with neonatal sepsis after 3 days we’re discharged from the hospital. Now he’s in picu for almost 2 weeks. Can I use again my philhealth for my child and how much is philhealth deductions for that case, thank you.

  551. Hi Lilet, so sad that was in 2013. It’s been one-and-a-half years. You should have gone to the hospital with your benefit payment notice from Philhealth, your hospital bill, OR and IDs and could have requested for a refund of part of what you paid. I don’t know if the hospital will accept your request for refund now; I don’t know if they have deadlines for refund requests. You can try if you decide so.

  552. Hi Lilet, Philhealth now accepts claims only from hospitals or clinics, with only few exceptions, so you file your Philhealth with the lying-in and your delivery will be covered by Philhealth. Ask how much is their newborn screening so you can prepare. Philhealth’s newborn screening coverage is only 1500, so maybe this is the reason why the clinic asks for additional payment.

  553. Ms nora last november 2013 I had cystectomy. I paid 40k to the private hospital, with philhealth coverage already deducted. I received a BPN from philhealth after 2 or 3 months with a check for 1 or 2k. I don’t know about reimbursement. The check that I received was my reimbursement? Or do I need to file something? thanks po

  554. Hi Ms Nors, I’m from Quezon City. I will give birth po this coming December at a lying-in center near us. They’re Philhealth accredited but their notice at their door says no payment except for new born screening. Can we reimburse at philhealth for any bills at the center? Thanks po for reply.

  555. Hi Arlene, after you receive your payment benefit notice from Philhealth, you can go back to the hospital, present your notice and hospital statement plus ORs of meds bought outside and request for a refund. Your refund amount will depend on your ORs and the amount from the 24k that can be allocated for meds (after the 10k hospital expense).

  556. Hi ms. Nora, I had an operation last aug 9, 2015 at a govt hosp. our total bill was 10K, all covered by phic so we did not pay anything except for meds bought outside. if 24k po is the fixed case rate for appendectomy, can we reimburse? about how much? thanks. god bless!

  557. Morning po ms. nora..scheduled for CS dis coming sept 5 2015. how much is philhealth deduction? tnx po.

  558. Hi Maam Nora, is endoscopy and gastroscopy covered by the philhealth? if so, how much is the philhealth deduction? thanks

  559. Hi melody, the coverage for chemotherapy administration is 7,280. The coverage amounts for other types of chemo are lower. One chemo equals 2 days. Every member is allotted 45 days per year.

  560. Hi sheila, sad to say, no. If you pay today for July to Sep, you can use it only in Sep or Oct or Nov. But I could be wrong, so ask the hospital.

  561. Hi paul, D&C coverage is 11,000.

  562. Hi can I use philhealth if I had no payment from January to June? Now my child has been admitted, can I pay and avail? Thanks

  563. My wife had miscarriage. How much is philhealth deduction from our bill so I would know how much to prepare. thanks po

  564. Hi Ms. Nora, my son was hospitalized and diagnosed with dengue fever, i am an ofw i want to know po if how much will be deducted from my bill for dengue fever. Thank u po.

  565. Hi ms Nora. My ninang was diagnosed with squamous cell carcinoma of the tongue. And she will undergo chemotherapy. Just want to know much is the coverage of Philhealth for this procedure/medication. Hoping for your answer. Thank you and God bless.

  566. Hi pearl, the coverage for hepatic amoebiasis is 10,000; for the other types, coverage is 6,000 pesos.

  567. Hi Joanna, sad to say, Philhealth’s rule is to pay the premium before the start of confinement. Besides, for July confinement, a member should have paid for Apr to June. But ask others too.

  568. Good Day. My daughter is currently confined because of Dengue. I want to apply for philhealth membership today. Can I use it immediately if I apply as member today and pay for 1 year contribution? thank you so much po.

  569. Hi Dissa, there’s the hospital deposit law, but I’m not sure if it covers a procedure after the patient has been hospitalized for weeks already. I pray for your continued strength.

  570. Hi po. My brother is confined. findings is amoebiasis po. philhealth dependent of my father. how much is the coverage of philhealth? indigent type of philhealth. thank you!

  571. Thank you, Nora. The doctor said my dad needs trach. We cannot afford to pay it nore because they want 100,000 upfront payment. Do you think it’s against the law not to give that procedure if its highly needed by the patient, just because we cannot pay right now?

  572. Hi Dissa, to get an accurate amount, go to the hospital’s Billing section and ask them. They should be able to answer because they know you need to pay, and the amount has escalated to a big amount.

  573. Hi, can you help me address my question. My father is in ICU for almost three months now because of kidney failure. On top of that, his lungs are failing, so he has to have the ventilator. Our hospital bill is already 800,0000. How much do you think Philhealth is going to cover?

  574. Hi Sheila, bring your signed claim form 1 to the hospital, with your cert of premium payment and ask the hospital to file for you. If they refuse because you’re already late, request the other claim forms, and file your claim at Philhealth yourself. Philhealth will accept your filing if they see a valid reason why you were not able to have your claim form 1 signed.

  575. Just given birth. What should I do to reimburse my expenses at the hospital. Wasn’t able to have my employer sign my cf1 form. Thank you

  576. Hi Ana, yes. Find a surgeon willing to accept Philhealth coverage. Ask how much you will add to the Philhealth coverage.

  577. Ana Mary O. Quirante

    hello po. would like to inquire if removal of small cyst outside at the back particularly in is covered to philhealth?

  578. Hi Merlyn, you should talk with your surgeon about using Philhealth because there are surgeons who are not Philhealth-accredited. The hospital should also be accredited. The coverage ranges from 23,300 to 49,000, depending on the specific surgery. Your doctor should be able to tell you about how much you need to prepare, after deducting Philhealth coverage. Your surgery date should be within the validity dates in your Philhealth receipt. Bring your MDR (from Philhealth), premium receipt and any ID. God bless too

  579. Hello po Mrs Nora, how much po is the coverage for ear surgery Tympanoplasty with Mastoidectomy middle ear, operation this coming July 15,2015. I’m OFW, just left Pinas last Dec 2014 and got back home to have my ear treated, so I don’t have much for the operation. What should I file? Thank you po and hoping for your immediate response. God bless.

  580. Hi Leo, sad to say, CT scan is not covered if it’s done as outpatient. Even if done while hospitalized, it’s likely that the benefit for the illness will be used up by treatments or procedures other than the CT scan.

  581. Mam Nora..kakatayo Lang po ng infirmary clinic namin..Hingi naman po ako ng sample computation para sa reimbursement..although I went through an orientation hindi ko po alam paano simulan..please help po

  582. Hello po, cover po ba ng philhealth ang laser treatment ng kidney stones? I yon po ang Sabi ng doctor at malaki ang mga bato. Kung pababayaan ay magiging grabe ang kalagayan. Ano PO ba ang dapat gawin? Salamat PO.

  583. Hi! Is CT Scan covered by PhilHealth? If so, how much is deducted?

  584. Hi Paul, under the TB-DOTS program, you can avail of 4k worth of meds and other services. Write where you live, so I can give a list of TB-DOTS facilities. P.S. I’ve emailed you the list.

  585. Hi po, how can I avail of benefits? My child was diagnosed with TB on June 2, 2015. He/she has been taking meds for a month as outpatient. What do to avail of benefits? Thank you very much. Kind Regards, Paul

  586. hi Ms Nora naoperahan po ako sa thyroid 2weeks ago umabot po ng 41k hospital bill gusto ko lang po malaman sana kung pwede pa rin po ba ko makapag refund para sa mga ibang expenses ko yung mga gamut po na nabili namin sa labas kahit nagamit ko na po yung 31k for thyroidectomy?maraming salamat po ms nora ….

  587. Hi Froscie,you should go to the billing dept and ask for billing balance and ask about philhealth coverage. i don’t know the main diagnosis so i don’t know what to check in the list

  588. Hi joy, yes, he can be a member. He brings his id/passport and your marriage certificate so he can register you as his dependent

  589. Gud pm. My child was born premature, 28 weeks gestation. now 29 days in the hospital. how much will philhealth cover?

  590. hi po can a us citizen married to a filipina be a member?

  591. Hi Ellen, sorry but your niece cannot be your beneficiary. Only your own children younger than 21, husband and senior parents can be your dependents

  592. Hi lorna, yes, 40% goes to PF, but if you have already paid for the PF before discharge, they should have refunded the PF benefit to you. Show your PF receipt to the hospital.

  593. good afternoon. my niece is in hospital due to multicab accident. he is 11 years old only. is he qualified as beneficiary in my philhealth? hoping for your response regarding this matter.

  594. Good day!! I would just like to clarify my refund from philhealth.i was operated twice last oct. For lap cholecystectomy and then roex-en hepatico jejunostomy with appendectomy..i paid my bill in cash without philhealth deductions..when i received my notice from philhealth for refund, 54300 was indicated in the notice..and when i went to the hospital,they only issued 24000 for my refund. 29400 goes to doctors fee(i have 3 doctors,1surgeon and 2 medical doctors in which 1 is just covering the other doctor because he’s out of town) just confused on the computation granting 40% for PF and 60% for hospital bill..

  595. nasa 130K na un hosp bill nmin, pulmonary at heart attack ang diagnosed ng doctor, how much will philhealth cover? ang unang sabi smin nasa 2K lng dw po ang ma-co-cover? how come?

  596. Hi Agnes, sorry I don’t know the exact procedure done, so I can’t research the list. Ask the hospital’s billing department for your partial billing

  597. How much is the coverage for varicocele operation?

  598. gud am po. My niece/nephew was admitted at QC Gen Hosp. Had operation on the head. Had titanium plate. We buy meds. How much is the Philhealth package? Patient is Philhealth member.

  599. Hi nanneth, sorry, but about 3 years have passed. Members are given only 60 days from date of discharge to file a Philhealth claim. Since last year, the rule has changed — it’s now the hospital that files the claim. The patient files with the hospital before discharge.

  600. Hello po. My husband died in 2012 due to hypertension, it was a sudden death. I was shocked so I wasn’t able to think well and use PhilHealth. It’s only now that I read on FB about refund. Can I still avail? Thanks!

  601. Hi bryoj, yes, that’s the policy. You use Philhealth at the second hospital.

  602. Is this really the policy? That if a patient transfers to another hospital, they cannot use Philhealth at the first hospital?

  603. Hi Ms. Nora!I would like to ask if cover dn ng phlhealthang RAI-131

    @jovie marasigan how much po quote n dr mu 50k po kc s chnese prang ang mahal

  604. Hi Ms. Nora!I would like to ask if cover dn ba ng philhealth ung s radioactive iodine theraphy? I just had my surgery this april because of papillary carcinoma can i still use my philhealth benefit by May w/ the same illness?

  605. mam/sir ask ko lang po how much cover ng philhealth ang RAI-131 or Radioactive iodone theraphy.

    thank you very much

  606. Hi, i just want to know the complete discount for Cholesteatoma Surgery?

  607. Hi Jessy, I can’t find hypocalcemia and low potassium in the Philhealth Case-Rate table. The benefit for hypertension is 9k. Usually, only one illness is covered. Talk with the Philhealth/billing staff, and ask about deduction. Ask about the PF so you can prepare. I hope your sister has already improved and is already well, so she can be discharged.

  608. Hi, Ms. Nors. how much is the discount for an individually paying member if confined? my sister is in the hospital from April 18 2015 to present due to HYPOCALCEMIA AND LOW POTASSIUM WITH HIGH BLOOD PRESSURE. Our papers are already with the billing department. Upon admission the hospital asked for a deposit of 2500 which I gave. (Bill that day was 4500+ and then after 2 days the bill became 11,800+ and they asked for 5k additional deposit and I complied, giving them 7,500. (TOTAL DEPOSIT is 10,000 as of that day.) Now it’s April 23, and the bill is 33,296.70 without PF. that’s the total running bill as of today without PF and deposit and Philhealth were not yet deducted. this morning, they called my mother to the billing section and they asked again for 10,000 additional deposit. Is this right? We were confined at a Level 3 hospital here in Pampanga. Hope you can help us

  609. Hi jennifer, not yet. Philhealth is used only when hospitalized. Can be used only for outpatient services like dialysis and chemotherapy.

  610. Hi po can we use philhealth card for outpatient care?

  611. hi mam nora:
    my got operated last week (apr 16) for hip replacement. she was admitted in a local hospital (Dr. Yanga Hospital in Bocaue). Our partial billing (frm Apr 9 to Apr 20, 2015 has reached P110,000.00 net of philhealth deduction amounting to P15,000.00. Is this the only amount being deducted in the case of my mother, how about the Z-package benefit, is she not entitle to this. Please note that I first brought my mom at the Phil. Orthopedic Hospital but upon informing the attending doctors there that my mom has polycythemia vera we were informed that my mom shld be brought to a general hospital. Since the hematologist treating my mom with her polycythemia vera is affiliated in Dr. Yanga Hospital, we opted to just bring her to the said hospital.I am just a rank-and file employee of a government agency and raising the amount billed to us is quite difficult.
    hoping for your immediate response.

  612. hello, philhealth covers only in-patient? my daughter had a minor surgery and ct scan pero out-patient…no coverage for this daw?

  613. Hi boss, ask your OB or clinic if that 21k package is already their Philhealth package, so that means you will pay the whole 21k. If not yet, ask if they deduct 6500 (for lying-in clinics) or 3900 (just the clinic portion). The normal delivery benefit at hospitals is 5k (3k for hospital cost and 2k for PF).

  614. Hi albert, the benefit is 12,120 (6,720 for PF and 5,400 for hospital cost)

  615. hi…just wanted to know when did philhealth started using fixed rate …the last time i used my philhealth they just deducted it directly from my hosptal bill.i thought they’re still using the old computation..

  616. Hi may i ask. I’ll give birth this coming may 23,2015. 21,000 is my delivery package at my clinic(philhealth accredited). I’m a member of philhealth. if normal delivery, how much will I get from philhealth? thanks po. last time i gave birth, my bill was 20,000, and only 2000 was deducted as my philhealth benefit

  617. my wife is a member of philhealth. she undergo surgical operation on hemorrhoidectomy yesterday april 11 and will be discharge tomorrow april 13. how much will be covered by philhealth. thank you

  618. Hi Rozaline, if in a hospital, the deduction is 5k (3k for hospital cost and 2k for OB). If lying-in, the deduction is 6500.

  619. How much is my Philhealth benefits just in case mine is normal delivery? Thank you.

  620. Hi Rozaline, ask the people in the service ward if they accept no-balance billing, meaning your Philhealth benefit is enough to cover all expenses, and that you don’t have to pay anything, or you pay only a little amount.

  621. Hi lauriz, the benefit for CS is 11,400 for meds and hospital costs and 7,600 for the doctors. So if your hospital cost was, for example, 5,400, and you spent 7k for meds bought outside, your 6k should be refunded to you (11,400 minus 5400 = 6k). If hospital cost was 4k and you spent 5k, you should be refunded 5k (11,400-4k=7400, but only 5k will be refunded). Processing takes 2 to 5 months or more.

  622. Good day! My due date is April 27, 2015. I plan to give birth at Amang Rodriquez Medical Center here in Marikina City. My O.B at OPD Section told me her rate for normal delivery package is 25k+ in Semi-Private with Philhealth. Then she mentioned Service Ward. I wish to deliver at the Service Ward as I can’t afford her rate. My husband’s salary is small. How much will I pay if I give birth at the Service Ward? I’ll use my Philhealth. Thank you

  623. goodmorning po, maam member po Ako at yung tatay ko ng philhealth, nais ko po sana magpa acl reconstruction, cover din po ba ako ng philhealth nya? Sana po masagot nyo tanong ko maraming salamat po

  624. Hi,ask ko Lang po kung magkano ang cover Ng lung biopsy sa philhealth kung sa east avenue po senior citizen na po sits pero bagong member pa Lang po.

  625. Hi I gave birth dec 9 2014 at a public hospital here in paranaque. I used my husband’s philhealth then all that were used for my cs were bought by us. how much is philhealth benefit if cs. we had no bill, but we spent for the meds and supplies. we were told we will get a refund. how much? how long before we can get our refund. they said they will text us, but we have not received any text up to now.

  626. hello po gud day!!may schedule po ako ng endoscopy magagamit ko po kaya ang philhealth ko? and how much po ang cover kung sakali? thanking you in advance for your reply 🙂

  627. Hi po! Ang pinsan ko po may acute glomerulonephritis. Magkanu po ang icocover ng philhealth kung sakali gamitin po. May philhealth po tatay niya. Thanks in advance for the reply.

  628. hello po ask ko lang sana kung cover ang dermoid cyst (ovarian cyst) operation sa philhealth,
    and ano po kaya ang rate cover nito…

    salamat po

  629. maam, gud afternoon po! tanong ko lang po if cover pa po ba ng philhealth ang operation sa tendon cyst?

  630. maam, good afternoon po!! ask ko lang po kung sakop pa po ba ng philhealth ang operasyon sa tendon cyst?

  631. Hi Emil, if your ACL surgery is this: Code 29888 – Arthroscopically aided anterior cruciate ligament repair/augmentation, Philhealth’s coverage is 37,180 (18,480 for PF and 18,700 for hospital cost). Ask your surgeon how much you will pay if you use Philhealth.

  632. maam goodmorning po, ask ko lang po kung magkano ang sagot ng philhealth sa aking acl injury surgery

  633. Hi simon, Philhealth’s coverage for this: Code 52649, High intensity Focused Ultrasound of the Prostate, including Transurethral Resection of the Prostate (TURP) is 16,800.00 for hospital cost and 21,000.00 for PF. Ask your doctor how much you will pay if you use your Philhealth

  634. mag kano pag TURP yung operation yung lilinisisn yung barasa prostate

  635. Hi kenneth, Philhealth’s coverage for varicocele excision is 12,900 and for the other type of excision, coverage is 14,960. There are 2 big government hospitals in Metro Manila: PGH and East Avenue. You can try the charity and pay-patient departments. If charity at PGH, you need to go there very early (Padre Faura gate). But if you’re working, sometimes it’s better to have the pay-patient route as the charity route takes a lot of waiting times. Ask the surgeon about costs

  636. Good day po mam. in what charitable hospital can I have have operation for varicocele and how much will be the cost? im 24 yrs old and member of philhealth. I’m thinking I need 20k to make sure I’ll be able to pay all so I’m saving now. thanks for the answer 🙂 God bless 🙂

  637. Hi Mylene, what I know is that if a patient is hospitalized due to 2 or more illnesses at the same time, only 1 illness is covered (the one with higher cost). there are conditions when 2 are covered, but usually the second case is chemo, hemodialysis and a limited list of medical conditions. Ask others too

  638. Hi gennifer, sorry Philhealth does not cover outpatient checkup. There’s a prenatal care benefit, but prenatal care ORs worth at least 1500 are filed together with maternity claim.


  640. Is evaluation for pcos included in the Maternal care package? I’m pregnant and I need check up. Will I pay if my philhealth is sponsored?

  641. Hi Mylene Mae, there’s Bell’s Palsy Facial Palsy in the Case Rate list and the coverage is 7,400. You can ask the hospital for refund or for claim forms and waiver from the hospital and file an appeal directly with Philhealth.


  643. Hi girlie, only 1 Philhealth coverage can be used, so only 1 of the 4 children can cover for her. Ask the hospital for the coverage because they know what exactly the treatment procedures are

  644. my mother in law was confined due to brain tumor. can philheath coverage be used under her 4 children who are members? and how much is the coverage for brain tumor

  645. Na confine father ko 3 days sabi ng doctor pneumonia skt niya package 15,000..bkt nakaltas lng ay 5,000..

  646. My goiter po ako 4 biopsy na po last year sept 2times pa lng po ako nkpag pa check up sa EENT clinic at kung e biopsy ako dun na din po .kung ma surgery po ba ako sa hospital private / public man . Mgmit ko po ba philhealth ko mag 1yr pa lng po ako member ng philhealth sa april.

  647. Hi Alli, I can’t see anything related to liver in Philhealth’s list of procedures considered for second-case coverage, so it’s most likely that only the hysterectomy coverage will be availed of. Ask your doctor

  648. Hello, my mother will undergo hysterectomy and at the same time will have something from her liver removed. Is there a coverage for that removal aside from the hysterectomy coverage since 2 surgeries are performed?

  649. I keep on searching on splenectomy coverage ng philhealth. Do you have any idea? Thanks

  650. Hi ilyn, Philhealth deduction now is not based on room rate or other rates. Now, the amount of deduction is fixed for every kind of illness or treatment, whether the room is service ward or private room. Ask the deduction for your kind of surgery.

  651. hello, good day, just want to ask questions how about for the room rates like on a service ward only how much is the philhealth deductions for that? we are an opd patient but asked for operation. Is the room rates still covered of the benefits its like for 1000 per day even its a service ward only. can you please answer my inquiry? thank you so much….

  652. Hi gemma, sorry I can’t compute your pension because I don’t have your SSS data. Here’s a sample computation:

  653. Hi emma, the coverage is 16k per eye (6400 for pf and 9600 for hospital expenses). Philhealth deduction should be availed of before discharge.

  654. How much discount ng operation ng tonsil my doctor said 60k all in so magkano discount nun? Thanks po sa reply

  655. hi, how much is the rate for cataract operation. We paid 15 thousand as pf.

  656. Hi Nora,
    Ill be an SSS pensioner next year. can you give me a sample computation for the sss pension payment so i can get an idea how much i will be receiving. Thank you so much. Can you email me your response.

  657. Hi Tomas, I checked the Procedure and Medical Case Rate list, and I can’t see “varicose”. But I think it should be covered. You can ask a surgeon about costs and Philhealth coverage. Meanwhile, you can research online for natural treatments.

  658. Is vslt or surgical procedure covered by philhealth?

  659. I have a very painful varicose vein buldging which cause me hard tostand and walk.I am 67 years old retiree and lifetime member. Is vstl or opration treatment covered by philhealth?

  660. Hi Sarah, yes, you can use it again for your son because you’re using it for different dependents. The 90-day rule applies only for the same patient and the same illness within 90 days.

  661. Hi, can I use philhealth again? My daughter was confined last oct 26 for pneumonia, can I use it for my son? pneumonia also. gap is 3 weeks

  662. Hi Jerico, yes, you can use your Philhealth this Nov or Dec. Get cert of premium payments from your employer. Continue paying as Individual Payor if you’re not yet re-employed. Requirement for both employed and individual payor is premium payment for 3 of the 6 months prior to confinement.

  663. Jerico Allano Moral


    Last payment ko po sa contribution ko sa Philhealth ay last month Oct. 2014, asked ko lang for if one of my dependent was confined on the Hospital can i still use my Philhealth for them?


  664. Hi Regine, is your father 60 years old or older? If 60 years old or older, yes, she can use her Philhealth for your father, even if she used it last Nov 6. But she needs to update her MDR (bring her birth certificate) if your father’s name is not yet written in her MDR. I heard that Commonwealth Hospital (near SM Fairview) is expensive; maybe you can bring your father to East Avenue, or think of more affordable private hospitals.

  665. Hi Irineo, I’m glad that you and your friends planned for your retirement and have been intently saving for the maximum SSS premium. Yes, the retirement formula is still the same. The formula that will be used in your case is Formula 2 above.
    Your advantages over your friends who did not contribute during vacations are: 1. You’ll have a higher no. of credited years (the formula for this from Year 2002 contributions is total no. of contributions divided by 12. So of course, the more contributions, the higher no. of credited years)
    2. If you continue to pay 1760, and assuming this will be the maximum premium till your retirement, and assuming you’ll be able to pay sixty 1760s till your retirement, then your average salary credit for pension computation will be the maximum 16k pesos.

  666. Regine Camille Coupon

    Good day Ma’am Nora. My sister used her philhealth last November 6,2014. Can she still use her philhealth for my fathers confinement in Commonwealth hospital because of heart failure? Pls reply Ma’am we need to bring my Papa as soon as possible as said by the doctor but we are very confused because we have not enough money.

  667. Hello ate Nora, I wrote you because this topic about sss pension is good. I’m ofw seabased. Since 1977, I’ve been paying my sss contributions through my employer if I’m on board. But I learned that if I continue to pay even during vacations, my retirement benefit will be higher. So since 2005, I started paying voluntarily while on vacation, but paid the minimum contribution just to prevent any gap in my contributions.
    In 2007, after getting advice from friends, I started paying the maximum contribution even while on vacation and still paying the max contribution amount of PHP 1760. Now I’m nearing the retiring age of 60. Is the retirement computation still the same, as what is written here? What I mean is–is my pension going to be higher than those who are also paying the maximum but not during vacations? Is there a significant difference? Thanks for explaining.

  668. Hi Magdalena, if your status with Philhealth is OFW (you can present your OEC or another proof of being OFW) and you pay Oct to Dec 2014, your mother can use it within Oct to Dec 2014. If you pay as Individual Payor, your mother can use it in January to Mar 2015. Your mother should be 60 or older so she can qualify as your dependent.

  669. Hi Ms. Nora, i am an OFW and my last payment was on June 2014. My mother needs a cataract surgery and she is my dependent. Can i still pay Oct-Dec 2014 this end of November? When can we use the benefits, is it next year (January?) if i pay my Oct-Dec? thank you in advance.

  670. Hi reuben, you can use it as many times as you need, up to the limits. The 2 limits are: 1. You have an allowance of 45 confinement days per year. Your dependents share another allowance of 45 days. 2. You can use Philhealth only once if you have 2 or more hospital admissions for the same illness within 90 days. If different illnesses within 90 days, these illnesses will be covered.

  671. May I ask how many times I can use philhealth in a year. thank you and more power.

  672. Hi Edna, the coverage for essential hypertension is 9k (6300 for hospital costs and 2700 for PF)

  673. Hi maam, my father is a senior and considered as a lifetime member of philhealth. He is currently confined at the hospital due to mild stroke. Would like to ask how many percent from Philhealth are we going to expect? Thanks,

  674. Hi jhoan, you can no longer pay for Sep. You can pay for Oct to Dec and the following months/quarters.

  675. Hi maam ask ko po i paid my husbands philheath yearly i forgot to settle it last september 18 can i still pay starting from that month onwards?thanks

  676. Hi rommel, yes, that’s really sad and frustrating. I looked at the Case Rate list and the coverage for coronary artery bypass (vein only, 1 or 2 venous grafts) is 53,400 (29,400 for PF and 24k for hospital expense). For 4 or more venous grafts, the deduction for PF is 37,800 and the hospital expense deduction is 21k (total deduction is 58,800). Have you received your benefit payment notice from Philhealth? You can ask for additional refund from the Heart center if your Philhealth deduction is less than the amount paid by Philhealth to Heart Center.

  677. Hi tesa, the coverage for acute asthma is 9k (2300 for pf and 6700 for hospital expenses). 2300 is deducted from your total PF and 6700 is deducted from your total hospital expense.

  678. Hi tess, sad to say, outpatient tests for possible dengue is not covered. Ask others too

  679. Hi! May I ask i I can claim from phic if it’s out patient with dengue condition? Required daily visit by doctor and daily blood laboratory. What should we do? Thanks

  680. If asthma hospitalization plus laryngitis and rhinosinusitis, are these covered? Is it per day or total hospital bill deduction? Thank you.

  681. Hi Gretchen, the coverage for hypertension is 9,000

  682. How much is the case rate for high blood? Thank you

  683. It’s so sad that philhealth is like that. We all in the family work for the government.

  684. Hi mam nora, why is it like that with philhealth? My mommy underwent coronary bypass at heart center, and our bill was almost 600k and only 21k was covered by philhealth. She was operated on last january. We thought philhealth will cover a big portion of the bill.

  685. Hi kath, he can pay for Oct to Nov or Oct to Dec, then he asks for a copy of premium payment or certification from his previous employer (payment for June and July 2014) so you can avail.

  686. Hi. I’m a dependent of my husband. Will give birth in dec. but his last payment was july. because his contract ended. can he continue paying and can i avail of benefit from philhealth? Thanks

  687. Hi elvie, yes, if different illness. If it’s pneumonia for the 2 confinements, the 2nd will not be covered if first was already covered. This is 90-day single period of confinement rule. Ask others too

  688. hi.. can my dependent still avail PHIC package of pneumonia even if he was diagnosed and admitted in the hospital in the same month?

  689. Hi Jay-Jay, the deduction is fixed now, not percent of total bill. If the diagnosis is more specific, then I can check the Case Rate list.

  690. Hello po…my baby is 6month old and got confined in hospital for 3days because of viral infection , how much does philhealth will deduct on our final bill in hospital? how many percent?
    appreciate your immediate response…

  691. Hi Raju, you can avail of Nos. 1 and 2. The 3rd is for those delivering normally. The hospital and doctors should be Philhealth-accredited.

  692. Hi, My wife is undergoing CS and I have PHILHealth for my dependent. Can I avail all 3 packages that covers under maternity?
    1. Newborn care package (NCP) 1,750
    2. Delivery by caesarian section (CS) 19,000
    3. Maternity care package (MCP) 8,000
    Please clarify. Thanks. Regards, Raju

  693. Hi jennifer, you can pay asap as individual payor for Oct to Dec, so you can be eligible Jan to Apr 2015. Update your record at a Philhealth branch (bring your ID) so you can get your MDR and your Philhealth card.

  694. my last payment was may to june 2014. that was before when i am ofw. now i stay in the phil. when can i pay again?

  695. Hi zoila, you present your Philhealth ng masa ID to the clinic/hospital and they will deduct your benefit. You’ll pay the balance if the Philhealth benefit is not enough. No more direct filing by member with Philhealth

  696. With the philhealth ng masa, can we reimburse? Thanks

  697. Hi Emily, sad to say, if you pay Oct to Dec, you can start using it in Jan 2015. Requirement is payment of 3 months within 6 months BEFORE confinement. Philhealth cannot be used for outpatient checkups. Ask others too.

  698. Good day! Last april 2014 was my last philhealth payment, when i was employed. Since end of contract, I haven’t paid. If I pay for 4th quarter, before Oct.13,2014 can I avail of benefits? that’s my schedule for my child’s follow-up checkup at the hospital?

  699. Hi sylvia, yes, you can both avail. File 2 sets of claim forms. The member has an allocation of 45 days. All the member’s dependents share a separate allocation of 45 days

  700. can both member and dependent avail of Philhealth benefits if they’re confined at the same time?

  701. Hello po. Pasenxa n if naitanong n ito at d lng aq nkpg backtrack sa comments pero po mgkno po ba ang rate for excision ng phyllodes tumor sa breast? Kc po i recently underwent operation s east ave med ctr..18k+ ung bill pero 8k lng po cngot ng philhealth.ask q lng po if tama po ba un?slmat po.

  702. Hi Josie, sad to say Philhealth’s coverage is too small compared to your sibling’s projected total bill. Check this list if that type of surgery is in this list:

  703. How much will Philhealth pay for my sibling who will undergo surgery at the heart Center for Double Valve Replacement surgery. He needs to pay 850,000.00 pesos for treatment.

  704. Hi ariel, if dengue 1, the coverage is 8k (2,400 for pf and 5,600 for hospital expenses). If dengue 2, coverage is 16k (4,800 for pf and 11,200 for hospital expenses)

  705. madam, my child is confined due to dengue. how is the computation for deduction from our billing. thanks! godbless

  706. Hi evangeline, the coverage for stroke is 38k (11,400 PF and 26,600 hospital costs). Keep the ORs (should be in patient’s name, with dates and OR nos.) and give the hospital xerox copies before discharge. You might be able to refund them later on if the 26,600 is not fully consumed by hospital costs. Get deductions before discharge; patient’s filing with Philhealth is no longer allowed.

  707. Hi Rose, the coverage for repair initial inguinal hernia is 21k (8,400 PF and 12,600 hospital costs).

  708. hi maam nora, magkano po ba covered ng philhealt sa stroke, confine kasi mother ko sa s.l.u baguio. at yong bang gamot na nabibili sa labas pwede po ba ererefund ng philhealth. thank you po.

  709. Hi Ms. Nora..I would like to ask how much will be covered by Philhealth in Inguinal Surgery for my son?

  710. I believe it’s their VAT that we pay for. Is that really how it goes, as per Philhealth guidelines? Do they have to have the patients pay for it?

  711. Hi rom, endoscopy is listed in the Case Rate list, but I’m not sure if it’s covered if it’s done as outpatient. Ask PGH

  712. Hi Ms. Nora! Yung father ko po need magpa’endoscopy s PGH next week, pwede ko po bang gamitin philhealth ko for the procedure?

  713. Hi shania, are you updated with your Philhealth payments? If you are updated, your Philhealth will be enough for your maternity and newborn care needs. You’ll file 2 claim form 1, one for you and one for your baby. You can also submit prenatal ORs worth 1500 or more so Philhealth can mail you your 1500 refund.

  714. Hi Cesar, I’m puzzled that they used the word “VAT”. Why didn’t they just say that it’s for additional doctor’s fee or hospital charge? What I know is there’s no VAT for regular medical bills. It’s the doctors and the hospital that pay VAT for payments received from Philhealth and from patients. You can ask if that’s really your VAT or their VAT (and you’re paying for them) or additional charge. They should just be honest.

  715. nora gud pm.

    6mos pregnant ako. may philhealth as voluntary. yung father ng baby ko ay philhealth member din under NHTS-pr . sponsored. We were asked to buy the hepa B vaccine since sa maternity clinic ako manganganak, gagamitin ko philhealth ko para mareimburse ko ycung 1750.00 NEW BORN PACKAGE, ano yung pwedeng gawin ng partner ko para magamit namin philhealth mya at makatulong sa gastos since my hepa B ako. o kaya dun nlng sa baby namin

  716. Cesar P. Arique Jr.

    Talaga po bang ide-deduct ng ospital sa claim na 11k yung VAT daw amounting to 2,800? 25 po yung total bill namin. Miscarriage po yung case.

  717. Hi jenny, only one of these diagnosis will be covered. Most likely, it would be pneumonia. Ask your hospital, to be sure.

  718. Hi Ernesto, these are all diagnostic procedures, and I commiserate with you because these are really expensive. Sadly, outpatient diagnostic procedures are not covered. In Philhealth’s list of Case-Rate procedures covered, endoscopy and colonoscopy are listed, and they have coverage amounts. MRI is covered only if it’s used during certain treatment procedures. So I think one diagnostic procedure can be covered if you’re confined and treated, meaning there’s diagnosis and there’s treatment. What I understand about Philhealth’s coverage, based on comments on our blogs and on rules I’ve read, is that there should be a diagnosis and treatment. If there’s no treatment done, even if confined, the confinement is not covered. But you need to ask your doctor or your hospital. They should know by now the conditions and procedures that can be covered when confined. Take care. I hope the doctors will finally make the right diagnosis and the right treatment. We emailed you the relevant case rate list.

  719. Hi I had severE stomach pain sometime in June and consulted a doctor who advised me to have laboratory test and ultra sound. The blood tests came out all negative except the ultra sound with enlarge prostate. I was prescribed medicines for acidic stomach and referred to another doctor for the enlarge prostate. The new doctor wanted me to have a biopsy of colon which I differed meanwhile my pain was persistently getting worst that leads me to go to another internest doctor who diagnosed me with ulcer. I was prescribed WITH some more medicine for ulcer, until the pain had traverst to my back that prompt me to go to another doctor a ‘diplomate for rehabilitation medicine’, who directed me to have an MRI and I was luckily rehabilitated from the pain but found out that I need to undergo further MRI, COLONOSCOPHY, & ENDOSCOPHY to further check the ‘cloudy portion at my THORACIC SPINE. ALL OF THE ABOVE PROCEDURES THAT ENTAILED HUGH AMOUNT OF EXPENSES WERE PAID BY ME BECAUSE ANYWHERE I GO I WAS ADVISED THAT THOSE WERE NOT COVERED BY PHILHEALTH. I AM SCHEDULED TO HAVE ANOTHER MRI, ENDOSCOPHY & COLONOSCOPHY AND ALREADY SHORT OF FUNDS TO COVER THESE FORTHCOMING EXPENSES, CAN I EXPECT PHILHEALTH TO DEFRAY THESE EXPENSES AND WHAT IS THE EASIEST WAY TO DO IT. THANK YOU AND I HOPE TO HAVE FAVORABLE RESPONSE AT THE SOONEST POSSIBLE TIME. REGARDS.

  720. hi.. may i ask… my son was admitted due to pneumonia and thyphoid fever. Is it possible that I can avail of 2 packages from philhealth? for pnuemonia and thypoid fever? thanks

  721. Hi Fel mar, the coverage for moderate pneumonia is 15k, and what I know is it should be 15k regardless if the patient is pregnant or not. Is pneumonia the diagnosis written in your discharge papers? Maybe it’s a maternity-related diagnosis with 6,800 coverage. You can see later on when you receive the benefit payment notice from Philhealth how much Philhealth paid the hospital.

  722. Hello po,

    Last wk naadmit po ako ung diagnosis po ai pneumonia (moderate risk) while i’m at my 14wks pregnant…tanong ko po magkano po ba yong package ng pnuemonia pagbuntis? Sabi ng hospital di daw 15k ang covered para s buntis kundi 6,800 lang…tnx!

  723. Hi Lanie, 2 cases can be claimed if the 2nd illness is on Philhealth’s list of conditions that can be covered as a 2nd case (100% coverage for 1st illness and 50% for 2nd illness or procedure). In the cases you mentioned, pneumonia might be the case covered since it has higher coverage. Sorry I don’t know if the 2nd diagnosis can be covered, as both illnesses are not in the list of 2nd case conditions. Ask your doctor.

  724. Hello,

    Ask lng po. Tama po ba ang deduction ng Philhealth if two cases ang diagnose (1) TB spondylitis / Pott’s Disease Php 9,800.00 and (2) Pneunmonia (moderate risk)Php 15,000.00.

    Ang both case ba is subject for hospital bill deduction?

    Thanks po.

  725. Hi jingelbells, you can use your Philhealth again because childbirth and breast mass excision are different conditions. You’ll submit the same Philhealth papers at East Ave upon admission, but since that’s a public hospital, you might be required to buy meds/supplies outside, then later on be refunded by the hospital. Find a Philhealth-accredited surgeon there, and ask about how much you will pay if you use Philhealth.

  726. Good pm po.i have just gave birth last saturday and have used the maternity package if philhealth and have an 8k discount. However becaude of my pregnancy,benign masses on my breasts started to grow again and i may need to undergo a mastectomy or excision of breast mass (still not sure since i will know nxt wk) my question is could i still use my philhealth since i have used it in my delivery? And do you know what are the requirements of East Ave med Center (philhealth req) for us to be able to prepare it before my surgery. Thank you and God Bless!

  727. Hi emy, is your friend the Philhealth member? If yes, she can use her Philhealth for her baby’s confinement, even if she has used it already for her delivery. She fills up another claim form 1 and uses the birth certificate issued by the hospital (Philhealth allows this, but if she can already get a birth cert from the local civil registrar, then it’s better). The father of the baby, if Philhealth member, can also cover the baby’s confinement. Can be father’s or mother’s Philhealth.

  728. How much is less at philhealth for mayoma operation if its in public or private I need to know ASAP thnks.

  729. Hi maam nor, my friend gave birth last august 23,2014 and was discharged august 25, but her baby remained at the hospital for infection treatment for 1 week. Can my friend use her philheath for her baby? The hospital said she can no longer use her Philhealth because she has already used it for her delivery

  730. Hi marilou, sorry the hospital should be accredited. Also, direct filing with Philhealth is no longer allowed.
    You can file only if the hospital is DOH-licensed and if you can prove it’s emergency and it’s impossible to reach the nearest Philhealth-accredited facility.

  731. naadmit po anak ko sa ospital na di accreditedalth ng philhealth pwede ko pa po bang mareimburse ang bayad ko sa hospital.two days lang po naadmit.tonsilopharyngitis at dehydration. thank you

  732. Hi mark, in the Procedure Case list, there’s a Code 66985 — Insertion of intraocular lens prosthesis, not associated with cataract removal, and the coverage is 16k. If you’re in QC, and if you like, you can visit Nova Eye Center at SM Fairview and look for Dra. Capinpin, or text 0919 991 1111 for Dra. Capinpin’s sked at SM Fairview.

  733. Good day, is eye surgery called phakic intraocular lens implant covered by Philhealth? How much will be the deduction? thanks and Godbless…

  734. Hi Maria, what’s the diagnosis? What I know is that if it’s not in the Case Rate lists, then the condition is not covered. All deductions now are based on the Case Rate lists, and no longer on the old hospital-level fee-based system. Here are the lists if you like to see:

  735. Maria Thelma C. Barrios

    I was confined at the medical city from Aug. 2-6, 2014.
    They did not deduct any philhealth benefit because according to
    them, my diagnosis was not included in the case rate. I got a
    leaflet from philhealth that if the confinement is not one of
    the case rate, I can still claim benefits(room and board/medicine/
    laboratories/PF according to hospital level.
    Can you please clear this?

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    your website has huge potential, for the monetizing method, just search in google – K2 advices how to monetize
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  737. Hi Maritess, coverage for Codes 44950 and 44960 Appendectomy is 24,000 (9,600 for PF and 14,400 for hospital cost)

  738. Ask q lng po magkanu po ang kltas sa philhealth kpag inoperhan po as acute appendicitis tnx

  739. Hi vench, sad to say, outpatient consultations are not covered. Outpatient MRI and other lab tests are also not covered. Lab tests are partly covered when they’re used during covered hospitalization or surgery. Ask others too.

  740. may discount b kapag ngpacheck up ako sa specialist? how much ang discount kapag nag-undergo ako MRI?

  741. Hi Ms.Nora…if its a hip replacement surgery how much will be covered by Philhealth.
    hoping for your immediate response.

  742. Hi kristine, it’s true that there’s no more direct filing with Philhealth by members. You should have submitted your Philhealth papers before discharge.
    But just to comfort you, I’ll say that if you didn’t pay the doctors and paid not much to the hospital, sometimes in a public hospital, that’s better than using Philhealth — there are cases when Philhealth is used, you pay a big amount to the doctor and the anesthesiologist because you’re a paying patient.

  743. Hi Ms. Nora ask ko lang po if nadischarge na sa hospital at hndi ngamit ang philhealth hindi naba pwede makapagfile ng reimbursement sa philhealth? nanganak kasi ako cs delivery sa isang public hospital ndischarge aq july 3,2014. Nong ngfile aq ng reimbursement sa hospital after 2 days dala mga receipts ng mga nbiling gamot sinabihan lang ako ng philhealth personnel ng hospital wala na daw refund ang philhealth.

  744. Hi Evangeline, depends on the kind of surgery performed, and if 2 coverages can be claimed (1 for surgery and 1 for malignancy condition). The surgeries on the list range from about 8k (cyst excision) to 22k (mastectomy). Ask your hospital.

  745. Tanong ko lang inoperahan kapatid ko dahil may early stage breast cancer sya, magkano po ang babayaran ng philhealth?

  746. Hi ana, for Code E87.8 Fluid and Electrolyte Disturbances, the coverage is 8,500 (5,950 hospital costs; 2,550 PF). Here are the Case Rate charts:
    I saw only neonatal cardiac dysrrhythmia (so this condition might be occurring in newborns only?), the coverage is 22,700 (15,890 for hospital costs; 6,810 for PF)

  747. Hi sammy, sorry for the delayed response. If the procedure is:
    Code 31630 — Bronchoscopy; with tracheal or bronchial dilation or closed reduction of fracture, the coverage is this:
    9,600 hospital costs
    8,400 PF
    18,000 total coverage

  748. Hi Jing, 10,500 is for hospital costs and 4,500 is for PF. After receiving your benefit payment notice (BPN) from Philhealth, xerox it and then ask your hospital for a refund of your 4,500. Bring your hospital bill and OR. While waiting for your BPN, you can also ask the hospital why the 4,500 for PF was not deducted from your bill.

  749. for other medical illnesses like electrolyte imbalance . cardiac dysrrhythmia where can we find the other rates thanks

  750. Hello po, nadischarge na po mother ko from hospital last saturday. Pneumonia po un sakit, then ang nakita ko lang na kaltas for philhealth is 10,500.00 should be 15,000.00 po di ba? Can I file for reinbursement if ever?


  751. My grandson will be undergo orthopedic procedure called closed reduction or wire fixation,how much do you think will be the deductions by philhealth for all the total bills for example 15 thousands

  752. Hi Levie, there are many types of biopsy listed in the Philhealth Case Rate for Medical Procedures. Ask your hospital to be sure. He can use your Philhealth as your dependent if he doesn’t have yet his Lifetime Member ID

  753. Ms nora im levie ask q lng po covered b ng philhealth ang biopsy? Ung father q kc nadiagnosed n my tb,but based s xray nya my nkitang prang bukol. Nirerequire po ng doctor nya n magpabiopsy. 62yrs. Old n sya ngaun philhealth member din po sya pero inactive n dhil retired n sya.

  754. Hi reiza, sorry, CT scan is not covered because it’s a diagnostic procedure. It’s only covered when the patient is hospitalized for an illness or surgical procedure covered under the Case Rate scheme. But ask the hospital.

  755. Hi Ms.Nora kasam ba sa discount yung CT scan.Thank You.

  756. Hi Ms.Nora,
    Ipapa CT scan ko po sana ang kapatid ko,17 years old sa private hospital.Bayad na po ako sa whole 1 year philhealth ko po.Thank You.May discount po ba kami dun.

  757. Hi Ryza, did you submit your Philhealth papers to the hospital? So you can refund from the hospital later on? Direct filing with Philhealth is no longer allowed, but you can try filing. Ask claim documents from the hospital. Or ask them if they can help you file, and you wait for refund. Include your premium receipt and MDR. Coverage for cholecystectomy, if it was the process that was performed on your husband, is 31k.

  758. Hi Juanito, it depends on the procedure used.
    Extracorporeal shock wave lithotripsy (ESWL): 18k (8400 PF and 9600 hospital cost)
    Nephrolithotomy; removal of calculus: 27,120 (15,120 PF; 12k hosp)
    Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy: 21,940 (9240 pf, 12700 hosp)

  759. hi im juanito d. Vidal can i ask the case rates payment of stone kidney problem…

    Thank you very much…

  760. Hi po, ask ko lang kung magkano ang dapat na ibawas ng ospital sa philhealth sa pagalis ng gallbladder ng akong asawa. Ma ire refund pa ho ba kung nakapagbayad na kami sa ospital at jaka labas na ang passenger?

  761. Hi herbert, no, you cannot refund the excess. The excess will go to the hospital.
    In many government hospitals where patients buy some meds and supplies outside the hospital, they can refund these costs if there’s excess coverage.

  762. hi Ms. Nora ask q lng po, mother q po is undergo medication for tb and was hospitalized for 2 weeks na po on a public hospital. She was a MDR-TB patient po. Ask q po sna un covered ng philhealth sa gnitong case and until anung maximum po kc sa case nya as per advised ng doctor mtagal po tlg ang gmutan. And in case po ma meet na po un maximum benefits kelan po ulit pede gmitin un philhealth for same case of illness po.

  763. herbert h. florido

    hi po.tanung ko lng po.ung anak ko ksi nconfine by june 1.pneumonia po..db po 15 k ang covered ng pneumonia pro 11k lng nging bill nmin s hospital…mat mkukuha ko p aq o refund b un s ksi ng iba knukuha dw nla ung sobra s covered ng philhealth.ksi ngbabayad nman dw po s philhealth..pls answer

  764. Hi Rosalinda, yes, you’re right. Should be 5k for normal delivery (3k for hospital and 2k for PF) and 4k for bilateral tubal ligation (2400 for hospital and 1600 for PF). It’s the PF deduction that sometimes changes, depending on the hospital and the doctor.

  765. Hi Miss Nora,

    I’m 6 months pregnant right now and a philhealth member. This is my 3rd child. Based on my previous 2 normal deliveries, Philhealth covered only 4000 on my hospital bill which is 8500. My plan now after giving birth on this 3rd child, is to have tubal ligation. And according to your chart above, 4000 is the fixed rate for this tubal ligation. In my understanding, it’s a total of 8000 pesos, I assume, will be covered or shouldered by Philhealth in my hospital bill in the future. Am I right? Please advise.

  766. Hi Ma’am Willa, Philhealth now has fixed rates for confinements. In their list, the coverage for myocardial infarction is only 18,900 (5,670 for PF and 13,230 for hospital costs). There must be a second diagnosis, so the hospital was able to deduct more. The discount for senior citizens is only for certain medicines. You can see how much Philhealth actually paid the hospital when you get your benefit payment notice from Philhealth via registered mail. You can ask for refund if there’s a discrepancy. Or you can ask the hospital directly details about their deductions.
    You can ask the hospital’s collection dept if you can still ask help from PCSO to pay part of your bill. The ideal process for PCSO is for the patient to be currently confined. I hope I won’t offend you, but you can also ask help from your politicians (from councilor to mayor to governor to congressmen). Many people are doing this, and they’re able to accumulate some funds. I know it’s so hard to ask for money from other people, specially that you worked so hard and proudly as a master teacher, but asking for help sometimes is the most feasible way.


    Hi Ms. Nors Thank you sa info..dko na po maalala kung nkailang years nko na sa philhealth..halimbawa po kung natapos ko na ung 120 months pero hindi deretso ung bayad counted prin un..ang ibig nyo po ba sabihin pwede na mag apply ng lifetime kung maka 120 months need pa po ba un magbayad or authomatic na un thanks po ulit sana po hindi kayo magsawang sumagot sa mga katanungan nmin..thank you at naliliwanagan kmi

  768. I am Mrs. Willa J. Ada a pensioner being a retired Master Teacher I of Sta. Catalina, Neg. Or. My husband, Eugenio D. Ada a pensioner too and 72 years old. He was at the ICU for 3 days and died last May 17, 2014. He has a massive attack due to Acute Myocardial Infarction at Silliman Medical Center. Upon discharge we have a bill of P141,000.00. But to my dismay being a Senior Citizen he has a deduction of P25,000 and Phil Health deducts P9,600.00 for Doctors’ Professional Fees. As I went over our hospital bills Philhealth has no deduction for medicines, drugs and others except for Drs’ fees. Please help me because until now we still have an account with SUMC. Thank you very much.

  769. hi tatanung ko lang po kung ang impeksyon sa dugo magkanu po ang cover??tnx

  770. Hi Maritess, if you accumulate 120 monthly premiums, you can apply for a Lifetime Free Philhealth card when you turn 60 years old. So keep your receipts. For OFWs, dates of confinement should be within the validity dates in the premium receipt. So pay your Philhealth in advance every year.

  771. Hi mona liza, yes, you can re-start again as Individual Payor. Payment deadline is the last day of the quarter. Eligibility requirement is payment of 3 premiums within 6 months prior to hospitalization. You can use your Philhealth for your father if he is 60 years old or older, but you cannot use it for his recent hospitalization, because payment of premiums should be BEFORE hospitalization.

  772. Hi rhea, for hospitals, the coverage for maternity benefit (normal) is 5,000 pesos. 1,500 is for prenatal care (if you submit prenatal ORs to the hospital). If your benefit payment notice (BPN from Philhealth via postal mail) is higher than your deduction, get your refund from the hospital (bring ORs, bill and BPN)


    Hi Ms. Nors Papaano po paghindi nagamit ang philhealth tulad po sa amin n OFW db naeexprired un every bakasyon lng kami nkakabayad..tapos bigla nmin kailangan makakaavail ba kmi nyan..thanks

  774. mona liza ola casan

    good day!

    by the way,i was a philhealth member for several years however, it was stopped when i transferred to an lgu school.If i will pay as voluntary,
    from april to june makakaavail ba ang father ko ng benefits? He is recently hospitalized.

    Hope to hear you soon.

  775. Hi rachelle, is the procedure thyroidectomy? Did the doctor ask if your in-law has Philhealth? The coverage for thyroidectomy is 31k. Maybe the 15k is for additional PF. Public hospitals have pay and charity departments. Philhealth is used in the pay dept, and usually not used in charity dept where PF is free but certain meds and supplies are paid. So ask the doctor about costs if you use Philhealth.
    Senior citizen discount is only for certain medicines, so the discount might not matter much.

  776. rachelle baricuatro

    hi po ask ko lang kasi maooperahan un inlaw ko goiter. sabi ng doc 15k daw iready nya sa PGH to. at pagkakaalam namin free na un prof fee. kung 15k un less n kaya philhealth or ileless pa. and sa mga Public hosp kaya eh ganun ang rate pag surgery sa goiter. may senior citizen pa sya. so idededuct muna un senior nya bago un philhealth? and di ko kasi knows un tinatawag n level ng hospital. san bang level ang PGH…. thank you.

  777. Hi,
    I am scheduled for cholecystectomy. I just went over rhe page says that in 2011 philhealth has its fixed rates or amounts on certain medical and surgical, for. Cholecystectomy its 31k, only on level 2-4 hospitals. What does it mean? Any private hospital? I am staying in pampanga and scheduled here. Thanks

  778. Hi,
    I am scheduled for cholecystectomy. I just went over rhe page says that in 2011 philhealth has its fixed rates or amounts on certain medical and surgical, for. Cholecystectomy its 31k, only on level 2-4 hospitals. What does it mean? Any private hospital? I am staying in pampanga and scheduled here.

  779. Hi En-en, what hospital is this? I like to appreciate this hospital for deducting immediately and for deducting the whole amount of 19k and for instructing you about possible refunds. 19k lang ang coverage ng Cesarean, so most likely na wala nang marerefund. Pero wait for your benefit payment notice from Philhealth, so you can see how much Philhealth paid the hospital. If it’s more than 19k (puedeng merong newborn care or other procedure), then you can ask for refund.

  780. Hi Ms. Nora, My itatanong lang poh, ahm I was in the hospital last Feb.2014, Im cesarian, the hospital deduct the 19,000.00 from my bill. pero my binili kami outside sa hospital na medicines na wala sila, tapus sabi nang hospital e compute daw naming total na bili naming sa labas ma refund daw ito 3 to 4 months pa. So possible bah my refund pa ako? or wala na kasi na deduct na lahat 19k. Please I need your advice. Thanks…

  781. Hi christopheron, sorry hindi ko makita ang blood clot due to injury. Blood-clot from miscarriage/abortion lang ang makita ko. Merong main diagnosis ang doctor at doon ibe-base ang deduction. Ask your doctor about costs so you can prepare.

  782. Hi ana, meron akong nakita sa Medical Case Rate list na malignant neoplasm of retina: 16,900 pesos (5,070 for PF; 11,830 hospital) at sa Procedure Case Rate list na enucleation of eye, with or without implant: 12,120 pesos (6,720 PF; 5,400 hospital). Sorry I’m not sure if that’s the condition and procedure. Ask your surgeon about costs so you can prepare.

  783. Hi Miss Nora..ako po si Ana…na diagnosed po kase un anak ko n may tumor sa mata(retinoblastoma).. ask me lang po if how much ang philhealth deduction for eye cancer surgery..tatangalin n daw po kase un right eye ..covered p po b siya ng philhealth?hindi po kase nakasama sa case rate…thanks po.

  784. christopherson domingo

    Hello po ako po si christopherson itatanong ko lang po yung case ng tatay ko nakasidente po sya at naadmit sa private hospital nag ka blood clot po sya kaya nasa icu sya pero sabi ng doctor makukuha sa gamot no operation needed ang tanong ko lang po magkano ang makokober ng philhealth sa case ng tatay ko… Tnx.

  785. Hi hello po ask ko lng po if may idea kau magkano po mukukuha s sss if mgffile ng claim, i undergo ESWL (Extracorporeal Shock Wave Lithotripsy) pra tanggalin ung stone dun s left kidney ko thanks a lot.

  786. Hi, ask ko lang po if puwede po bang mag claim sa PHILHEALTJ ang isang OFW sa ibang bansa if he was undergo for a medical treatment of TB.

    Nagbabayad po kasi siya ng more than 3,000 pesos everytime na may checkup and blood testing siya every monthy.

    6months daw po kasi ang pagga gamot sa kanya sabi ng hospital. hindi nga lang siya naka confine pero under treatment po siya, Salamat

  787. Hi Shirley, hindi listed ang surgery for double aortic arch sa Z package, pero kung related ito sa surgeries for tetralogy of fallot or ventricular septal defect, meron. Meron ding coronary bypass. Merong congenital heart diseases sa Case Rate (puede sa Procedure Case Rate List at sa Medical Case Rate list). Talk with the surgeon about costs and Philhealth. Sa PGH, kalimitan you buy first some meds and supplies and you pay the surgeon; I’m not sure kung ganon din ang practice sa Heart Center.

  788. Hi Miss Nora. My name is Shirley. Ask ko lang po kung kasama yung diagnosis na double aortic arch sa Philhealth’s Z package? May pamangkin po ako na na diagnosed ng ganong congenital heart problem.Bali 6 months na po sya at surgical intervention po ang kailangan. Tanong ko rin po kung yung Philippine General Hospital at Philippine Heart Center eh kasama sa list ng hospitals na affiliated for Philhealth’s Z package?? naguguluhan po kasi kami kung alin sa dalawang hospital namin sya paooperahan sa kadahilanan limited lang po yung budget namin for hospital billing.
    Maraming salamat po in advance and looking forward to your reply.

  789. Hi mira, anong treatment ang ginawa ng hospital sa dislocation? Meron akong nakitang temporomandibular sa RVS codes 21480, 21485, 21490 sa Procedure Rates. Meron ding RVS codes 29800, 29804. This is the list:

  790. Hi ruel, for the same patient and the same illness, magamit uli after 90 days (90 days after start of previous confinement)

  791. tanong ko lang po mam ilang beses ko pong maaring gamitin ang philhealth sa parehong karamdaman ? Pneumonia 1 – Moderate Risk

  792. Hi ms. Nora,
    My mother was confined for 3.5 days in the hospital. When she was discharged the hospital said that the case of my mother illness is not listed in medical / surgical cases of philhealth. Final diagnosis is temporo mandibular joint dislocation. How would I know that this is not included in the claims.

    Best regards,

  793. Hi Emm, wala akong makitang circular na expressly sinabing ganon. Pero ang standard Philhealth procedure, as you know, ay dinededuct ng hospital ang Case Rate sa bill, then Philhealth pays the hospital. Kung merong sobra, mapupunta ang sobra sa hospital. Hindi na ibibigay sa pasyente. Puede lang sa sitwasyon sa government hospitals na pinapabili ang pasyente ng meds/supplies sa labas; in this case, present the ORs to the hospital for refund.
    I assume na ang inisip kasi ng Philhealth when they listed the Case Rates (kasi based sa surveys and studies ang Case Rates), walang hospital ang sisingil ng mas mababa pa sa Case Rates. Kung tutuusin, kahit anong presyo ang gusto ng hospital ay puede kasi walang government agency na nagkokontrol. Naisip din palagay ko ng Philhealth na ang government hospitals ay puedeng sisingil ng mas mura, kaya merong No-Balance-Billing, pero government hospitals naman, so ok lang na mapunta ang sobra sa government hospitals. Ask others too.

  794. anong circular or memo ng philhealth ko po makikita na ang sobrang halaga ng case rate ay mapupunta sa hospital at hindi sa miyembro ng philhealth. maraming salamat po..

  795. May I know what circular or memo will I see that the excess case rate will be benefited by the hospital and not the member.

  796. Hello po. My name is Shirley. Ask ko lang po kung kasama yung diagnosis na double aortic arch sa Philhealth’s Z package? May pamangkin po ako na na diagnosed ng ganong congenital heart problem.Bali 6 months na po sya at surgical intervention po ang kailangan. Tanong ko rin po kung yung Philippine General Hospital at Philippine Heart Center eh kasama sa list ng hospitals na affiliated for Philhealth’s Z package?? naguguluhan po kasi kami kung alin sa dalawang hospital namin sya paooperahan sa kadahilanan limited lang po yung budget namin for hospital billing.
    Maraming salamat po in advance and looking forward to your reply.

  797. Hi Yett, inguinal hernia ito? (sa scrotum or groin?) If yes, ang coverage is 21k (8400 PF, 12600 hospital cost). For both private and public, dapat deduction, kasi bawal na ang direct filing by patient with Philhealth. Pero maraming public hospitals na pabibili muna ang meds/supplies and then refund later on if gagamit ng Philhealth. I-compare mo na lang ang PF ng surgeon sa private at sa public. Pero ask pa rin the coverage amount, para sure na tama yong hernia type na tiningnan ko sa list.

  798. Hi Ms. Nora, I’m Yette from Antipolo. Papaoperahan ko po kasi ang 7 year old son ko ng hernia sa private hospital dito sa Antipolo kaso masyado pong mahal. Kung sa government hospital ko po sya papaoperahan, magbabayad po ba muna ako tapos saka irireimburse sa philhealth o pareho lang sa private na ibabawas na nila ung share ng philhealth? Thanks in advance and God bless!

  799. Hi Elayne, ang coverage for hemorrhoidectomy is 12,120 pesos (6,720 for PF and 5400 for hospital cost). Find a Philhealth-accredited surgeon. About single status in Saudi: I-analyze nio na lang kung merong paraan para malaman ng employer at agency ang true civil status niya kapag gamitin ang Philhealth. Kasi pag gamitin ng husband ang Philhealth, she needs to update her Philhealth data/MDR and register her husband as her dependent (show marriage cert) through authorization letter (authorize husband) and copy of her ID (puedeng through email) and copy of OEC receipt and/or Philhealth premium payment receipt. May conflict ba sa surname? Mag-member na lang kaya ang husband sa Philhealth para no worries.

  800. Hello po.. Gud pm.. I have a question about my friend’s case who is working in saudi arabia.. I just want to ask if her husband can use her philhealth benefits who is in the philippines? Kc po ung nakalagay sa poea contract ng friend ko is single, hindi po ba macocompromise ung work nya sa saudi? Thanks po.. Another question po, hindi po ba kasama sa lists ng operation ung hemorrhoidectomy? Thanks

  801. Hi Reichelle, yes, Philhealth evaluates the claim before paying their share of the bill. Check if you were not really eligible that time, and if not eligible, you can ask to reimburse them in installments (keep your payment receipts). Your future claim might be denied if you don’t reimburse them this one.

  802. Hi, good day.
    Ma’am, may i ask the verification process of philhealth before they approve the benefits to be availed by the philhealth member. In my case, my son was hospitalized last 2013, then thinking that i was eligible of the benefits I filled out a form and they approved of paying the hospital bill. Almost a year later now, I received a letter from philhealth office stating that i have to reimburse the amount they paid when my son was hospitalized. Mam, don’t they check the contributions made before allowing members to avail?
    Thank you, Ma’am.

  803. Hi Evangeline, if your daughter was under 21, unmarried and unemployed when she had her cyst surgery, she was eligible as your dependent. Did the doctor file your Philhealth claim for your daughter? About your cyst surgery, find a surgeon who is willing to accomplish Philhealth papers. Coverage for simple cyst surgery ay 3,640. Ask the surgeon para sure.

  804. Hi Rico, sori hindi ko masagot, kasi masyado nang delayed na, so ask na lang the nearest Philhealth. Present envelope so they can see the post stamp.

  805. Hi Mark, covered lang ang CT scan kapag confined due to illness, pero merong new rule about outpatient diagnostics; hindi ko sure kung inaapply na ng mga hospitals at kung kasama ang CT scan (in the procedure case rate list, I can’t see CT scan linked to meningitis). Ask them na lang. About meningitis, covered ito if confined.

  806. Evangeline N. Hilario

    Hi good morning im Evangeline N. Hilario , i have a cyst in my underarm and ill be having my operation this april .i would like to know if i can use my philhealth and how much is thhe benefits i could get .one thing more my daughter had her operation also for her cyst on her chest a year ago, we apply for the philhealth but until now there is no reimbursement.Is she qulified as my dependent?

  807. My hospital reimbursement was denied due to the doctor’s failure to renew his accreditation, tumawag po ako sa philhealth lucena at sabi nila sa akin antay ko daw papers ko galing sa kanila para mag attach ng letter of appeal na galing sa amin at sa doctor.

    Ang problem po is February 2013 ko sila tinawagan to ask kung napadala na yung pepers, ngayong April 2014 ko lang po nareceive yung mga papers. Nagtuturuan po kasi ang philhealth at philpost nung nagfollow-up ako kung nasan na yung papers ko. lagpas 1 year na po ang lumipas, ma-rereimburse ko pa po kaya yun?


  808. Hello. Can anyone give me info on coverage for meningitis and a CT scan performed to aid in the diagnosis? If any benefit is available is it only if admitted as in-patient!? Thank you.

  809. Hi al, coverage amounts are the same for member and dependent.
    Philhealth is now using fixed coverages for surgical procedures and medical conditions, regardless of the actual hospital costs. 2 procedures or conditions can be covered per treatment; but the second condition or procedure gets only 50% of the fixed coverage. There’s also this single-period-of-confinement rule: only 1 confinement is covered if one is confined/treated again within 90 days for the same illness. Exceptions to this rule are hemodialysis, chemo, etc.
    I’ll give you the links to the lists.
    These are long lists, so press Ctrl F, so you can type pacemaker to search coverages for various pacemaker procedures.
    Regular health insurance here I think is not useful because it’s the no. of confinement days that they pay, not the hospital cost. It’s the HMOs that are popular here, specially among employees. Maxicare, Medicard and Intellicare are 3 of the most popular. You can search: / / Check their rules on pre-existing conditions.

  810. Tanong ko lang po kung ang beneficiary ng gsis member na may pacemaker ay covered? at ano-ano po ito? katulad po ng mga sumusunod
    1. dr. visit (primary dr. at cardiologist dr.)
    2. blood test
    3. warfarin medicine for blood thinner
    4. adjustment of pacemaker rate
    5. surgery or replacement ng pacemaker
    6. hospital stay
    7. separate po ba ang pacemaker sa babayaran sa surgery?
    (kung hindi po covered philhealth ay mayroon po ba kayong mai-susugest na ibang health insurance.
    salamat po ng maraming-marami.

  811. Hi judith, sad to know that Philhealth processing is still taking so long. If you have time, you can go to the nearest Philhealth branch and ask if your claim was really filed by the hospital.

  812. gud day sir/madam, ask ko lang po kung may marereimburse po ako, i was hospitalized and confined in a public hospital last sept.10-13 2013, i paid all the medicines, upon discharge i submitted all the needed requirements for reimbursement of the medicines i had bought. but up to now wala pa po kaming narerecieved na benefit of payment notice from philhealth.. thanks po.

  813. hi Alvin, anong body part ang iba-biopsy? Sa Philhealth list, maraming kinds of biopsy: breast biopsy by needle core 3,640 (840 pf, 2,800 hospital); breast biopsy by incision 5,560 (1,260 pf, 4,300 hospital); biopsy soft tissue 3,504 (504 pf, 3,000)

  814. Hi boss, ask ko lang magkano ang covered ng phil health for biopsy for dependents?

  815. Hi Angelie, submit your Philhealth docs to the hospital para ma-deduct ang 4,500. Keep your bill/statement of account, ORs and receipts of purchases outside. Wait for your benefit payment notice from Philhealth. If the notice shows that Philhealth paid the hospital 15k, go back to the hospital and refund what you spent for meds purchased outside. The hospital might have other instructions.

  816. Hello,

    I have a question po. My son was admitted last week THursday. His diagnosis is Pneumonia. Our total bill is 4,500 however the amount covered by philhealth is 15K. May refund po ba ako?I also
    buy medicines outside the hospital. May refund ba rin ba yon?

    Thank you.

  817. Hi Riri, yes, covered kasi andon naman ang gastrointestinal endoscopy sa List of Procedures covered. Range from 10,540 to 18k ang coverage, depending on specifics. But you need to ask your doctor if you can use your Philhealth.

  818. hi po. ask ko lang po kung covered ng philhealth ang upper Gastrointestinal endoscopy? sabi ng doctor 8500 daw aaabutin. if covered magkano po kaya? maraming salamat po.

  819. Hi Ella, yes, you can again use Philhealth because hysterectomy is a different medical condition from ischemic heart disease. To be sure, ask the hospital too.

  820. Hi po,
    I want to ask something, i’m OFW in my mother was hospitalize 2 months back with Diagnosis of Ischemic heart disease, and we used my phil health, now she is schedule for hysterectomy can we still use my philhealth? Pls do answer my question. Cause ‘m afraid its not allowed to use it with that very shot time interval..

  821. Hi Sheryl Mae, sad to say hindi na covered kapag the same diagnosis within 90 days. Ask the hospital too.

  822. Sheryl MAe Villasor

    Pwede po vah mag ask ang Baby ko kasi na Confine last Feb. 9-2014 og pneumonia and then this March 31-2014 pina confine ko na naman kasi hindi nawala ang ubo tapos may fever sya maka avail pa bah kami sa philhealth benefits if pneumonia parin ang findings?

  823. Hi Christine, register as Individual Payor-Informal Sector, pay this March for March 2014 to Feb 2014 (one year) so you can use it immediately. Ask Philhealth too.

  824. Hi po. Philhealth member po ako (under self-employed) pero inactive since 2012 (huli kong nabayaran January to march 2012).
    Magagamit ko ba agad Philhealth ko para sa ESWL after ko bayaran from April to December 2014? Thanks po.

  825. Hi Gaylord, hindi ko sure kung eligible ka, kasi dapat yong dates of confinement mo ay within the validity dates in your premium receipt. Kung wala namang bayad ang docs diyan, try filing. Document requirements: Submit within 180 days after discharge. PhilHealth Claim Form 1, MDR, premium payment receipt, OR or detailed statement of account (written in English), Medical certificate (written in English) indicating final diagnosis, confinement period and services rendered

  826. Hi maam…good day…ask ko lng sana kung maka avail ako ng benifit kc naospital ako d2 sa abroad ngayong march 2014,tinahi po yung nasugat na legs ko at na confine ako ng 2 weeks..nakabayad ako sa philhealth via POEA e-receipt from dec.2012-dec.2013 ngayon di ako nakabayad ng january 2014 hanggang 3rd week ng march ,nagbayad nalang ako 3 days before ma discharged ako d2 sa hospital..kung maka avail ako anong requirements na ipapasa ko at saang philhealth branch? Taga ilocos region po ako..

  827. Hi ma. rachel, yes, if she paid for 1 year this March, and she is an Individual Payor-Informal Sector, then she can avail

  828. ma. rachel bismonte

    Hi. I would like to ask about the case of my relative. she applied in philhealth just this march and she will be going to deliver her second child this March also. what if she already paid this March for 12 months already. Can she avail the philhealth benefits when she give birth to his child? Thank you

  829. Hi Grace, Philhealth’s coverage for the administration of chemotherapy is 5,600 per session, so yon lang ang nabawas. Ask Philhealth kung puede niong i-claim yong medical condition na Hodgkin’s lymphoma, kahit nadeduct na yong for chemo, kasi according to you, parang hindi pa nila gamay yong Case Rate list. Sabi sa Case Rate rules, puedeng mag-claim ng 2, puedeng 1 medical condition and 1 procedure. Sa Case Rate list ng Philhealth, merong Hodgkin’s disease, hindi ko sure if this is the same as Hodgkin’s lymphoma. Ang meron ay non-Hodgkin’s lymphoma. Pare-parehong 13,900 ang total coverage.
    For the next chemos, ganon uli na 5,600 per session.

  830. ung sister ko po mismo na may hodgkins lymphoma ang member ng philhealth.thank you po ulit.

  831. hi ma’am nora.ask ko lang po.may hodgkins lymphoma po kasi ung kapatid ko.she had her 4 cycles ng chemo sa ust last year..for reimbursement po kasi ung philhealth dun pag outpatient.nakareceived po kame ng checks na ang amount po is equivalent dun sa binayaran namen sa chemo nya.tapos po nag recur..ngayon po chinemo sya peo inpatient na po.ang bill namen is almost 50,000.00 pro po ang na less lang is 5,600.00.bakit po ganun?tapos po nagkakaproblema pa sa rvs code or icd code.dati naman po..wala pong isinusulat ang mga doctors sa cf2 na mga code.anu po ba ang code na dapat ilagay nila?tsaka po..ganun na lang po ba talaga kaliit ang makakaltas ng philhealth?meron pa po kasi syang 5 sessions ng chemo.sorry po ha..ang dami kong tanung.badly need your reply po.thank you po ng marame.

  832. Hi lynn, ang coverage ng Philhealth ay:
    Ask the hospital kung magkano ang gasto so you can prepare. Sa PGH or other public hospital, usually bibilhin mo ang karamihan ng medicines or supplies sa labas before the operation.

  833. Mam ask ko lang po magkano opera ng myoma sa private hospital at public like PGH meron po kaming philhealth.thank you po.

  834. Hi Luzviminda, kung ito yong treatment — intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC per session — ang coverage ay 5,680 pesos (1,680 for PF and 4k for hospital)

  835. Luzviminda Cabigao

    Hi Im Lhuz. Ask ko lang po magkano ang covered ng philhealth for imrt at the lung center of the philippines.

  836. Hi Danmar, if you already have received your benefit payment notice from Philhealth via postal mail, you can get your refund from the hospital. Or kahit wala pang notice kung sabi ng hospital ay meron nang refund (sabi mo na-post na), bring your ID and ORs. and get your refund. Usually it takes months to get a refund (from filing with Philhealth to receiving the notice).

  837. Danmar s. bonghanoy

    when can i get my refund, Minglanilla District Hospital already posted my name last March 6, 2014

  838. Hi Julie, yes, covered ang UTI; 7500 ang coverage (2250 for PF, 5250 for hospital). Submit your Philhealth documents to the hospital before discharge. No more direct filing with Philhealth.

  839. Hi! Ask ko lang if me benefits from philhealth na pede ma claim for confinement ng anak ko sa second level hospital, private hospital po. Me UTI ho sia kaya nagsusuka sia at na dehydrate. Thank you po!

  840. Hi piboy, yes, covered. Ang coverage ay 10,100

  841. Hi Adelina, Philhealth-covered ang septic shock ng 32k. Covered din ang pneumonia, at ang coverage amount ay depende sa klase ng pneumonia. Pero usually ang covered ay yong main illness. Dapat i-file ng Sinai ang Philhealth claim nio, lalo na at merong 60-day deadline ang filing. Hindi na puedeng direct filing ngayon sa Philhealth.
    Puedeng manghingi ng assistance sa PCSO pero dapat kausapin nio ang collection/billing ng hospital kasi sila ang magbibigay ng ibang required docs for PCSO.

  842. Hi Ana, usually ganon nga na dapat confined for at least 24 hours para ma-cover. Pero magtanong ka pa rin sa billing department.

  843. my brother in law was confined in the ICU of SInai Hospital for two days, since they don’t have the resources to pay for the 130,000 thousand pesos, they transfered hin to the Seaman’s hospital,according to Sinai Hopsital wPhilheath benefits can not be aviled by my brother in law since his sickness is not a disease according to them, he was diagnosed with septic shock/pneumonia. pls. enlighten us on these since my sister is having a hard time raising the 130 thousand bill from Sinai Hospital.

  844. Naconfine ang anak ko at nadiagnose na rheumatic fever, meron bang medical case/case rate ito sa philhealth?

  845. paano po ang mag avail ng programa para sa tb dots? ano ang requirements o saan kailangang pumunta? kelangan bang magpa enroll para sa programa na ito? nag positive sa tb tests ang dalawa kong anak at kakasimula pa lang namin ng gamutan. matagal na akong miyembro ng philhealth. salamat po.

  846. Good evening. My father, who is 72 years old and is one of my dependents, is confined right now and baka for discharge na rin siya tomorrow. If ever po yun ang maging case, covered po ba ng Philhealth kapag less than 24 hours ang confinement? Or we have to pay all the hospital bills. Thank you so much.

  847. Hi eduardo, na-stroke ba siya? Ang coverage ay depende sa diagnosis code and treatment code na isusulat ng doctor. Puedeng isang kondisyon lang ang ma-cover, puede ring 1 condition and 1 procedure. Based sa new case rate list, ang coverage for stroke ay 28k or 38k depende sa type of stroke (28k = 8400 for pf at 19600 for hospital; 38k = 11400 for PF at 26600 for hospital). Magtanong sa billing dept ng hospital

  848. hi po,tanung ko lang po kung mgkano ma aavail ng kuya ko, under coma stage siya ngaun, may pumutok daw n vein s utak nya and he is also a dialysis patient.thanks in advance po.

  849. Hi Mel, ito ang nasa Case Rate list: excision of varicocele or ligation of spermatic veins for varicocele, coverage is 12,900 (6300 for PF and 66 for hospital cost). Kapag abdominal approach or with hernia repair, coverage is 14960 (7560 for PF and 7400 for hospital cost)

  850. Hi ron, merong acute nephritic syndrome sa Case Rate list at ang coverage ay 10k (3k for PF and 7k for hospital cost)

  851. may i know how much will be covered by PHIC for nephritis?

  852. ano po case rate ng nephritis?

  853. Hi po, i was diagnose with varicocele(varicose vein sa scrotum), and sabi po ng Dr. that i need to undergo varicocele repair kasi more than two years na kami nahihirapan magkababyng wife ko. i was checking yung case rate sa philhealth kanina pa pero di ko alam kung san case rates under yung varicocele or kung covered siya sa philhealth, please help po thank you

  854. Hi Eric, yes, the same benefit amount for a certain condition or procedure kahit anong level, except sa normal delivery benefit (5k pag hospital pero 6500 pag clinic). Ang difference related to hospital levels ay merong mga procedures na hindi covered by Philhealth if done at level 1 hospitals.

  855. same pa din po ba ng kaltas sa all case rate kapag ang ospital ay LEVEL 1 CATEGORY lamang. salamat po….

  856. Hi Gil, sorry hindi ko ma-determine kung anong bukol yan, kung cyst yan o kung anong growth yan, para ma-check ko yong Case Rate list. Hindi rin ako doktor. Maganda kung magpa-checkup ka muna para makita ng doktor kung ano yan. At sana pa-checkup ka na asap para maagapan at hindi lumala kung anuman yan.

  857. Hi tonton, ang coverage for repair of inguinal hernia (luslos) ay 21k (8400 for PF at 12,600 for hospital). Tanungin mo sa doctor mo kung magkano ang bayaran mo pa kung gamitin mo ang Philhealth mo. Okay rin na mag-research ka muna ng hernia/luslos Dr. Gary Sy sa baka puede pang maremedyuhan na hindi muna surgery.

  858. Hi, My father is a philhealth dependent of my Sister. He will undergo ESWL, which is a normally outpatient procedure. Can we avail philhealth benefit for outpatient procedure?

  859. Good Morning,

    Meron po akong bukol sa likod. Gusto ko po ipaopera para matanggal. Magkano po ang covered ng Philhealth dun.

    Thank you.

  860. im tonton ng ka luslos po ako at gusto ko pong mag pa opera bago pa lang po ako sa philhealth ma aavail ko ba ung benifit

  861. Hi aireen, kung Individual Payor-Informal Sector, after 3 months, puede mo nang magamit. Kapag kelangan na talaga, ask Philhealth kung magagamit mo agad if you pay 1 year in advance as Informal Sector member

  862. Hi Bing, based on the Case Rate chart: J15 pneumonia coverage is 32k (22400 hospital; 9600 PF). Ovarian cancer’s coverage is 11400 (7980 hospital; 3420 PF) Hindi ko sure if both conditions are covered if they’re co-occurring. Pakitanong na lang

  863. Hi Bing, Philhealth now does not accept direct filing, based on their new circular and on new comments here, so submit your Philhealth papers to PGH before you get discharged. After receiving your payment notice from Philhealth via mail (usually after 2 months or more), you bring this notice plus your bills, hospital ORs and medicine ORs to ask for your refund from PGH. Keep copies. PGH might also have additional instructions about Philhealth claims.

  864. hi poh,
    ask ko lang po,kung ilang month magagamit yong philhealth, pag magpapa member ka sa philhealth?


  865. Follow up questions. My CF2 discharged diagnosed are pneumonia-ICD-10 Code: J15 and ovarian cancer – ICD-10 code: C56. How much will be deducted from my bill in terms of this Case Rate of benefits from philhealth. Thanks again.

  866. Good day, i am presently confined at the pgh. Still waiting for the result of immunohistochem of the biopsy ultrasound guided thru needle. My questions are the ff: 1) PF of doctor-radiologist and procedure done was paid separately and not included in the billing of my hospital bills; 2) PF of histopathologist was also paid separately; 3) PF of the doctor who will sign the result of immunohistochem were also paid separately; 4) PF of reliever-doctor of my pulmo doctor were also not included in the bill; 5) all medicines i bought outside the hospital. Can i claim all of these from philhealth? Thank you.

  867. Hi Florita, based on the new Case Rate list, the coverage for myomectomy, abdominal approach is 23,300; vaginal approach, 18k. kasama na diyan ang coverage for PF. Ask your surgeon his/her PF and hospital cost, if with Philhealth coverage, so you can prepare.

  868. Hi Ma’am!

    I am required to undergo myomatechtomy or removal of my myoma. My question now is, how much will be the coverage of PHILHEALTH for this procedure. I am planning to have my surgery in a private hospital with a private doctor. Hope you can give me an idea.


  869. Hi Mariell, sa old system, hindi covered ang mga outpatient diagnostic procedures. Sa new Case Rate list, hindi ko makita sa list ang MRI. Merong mga diagnostic procedures na covered sa list, pero ito yong mga more invasive diagnosis, katulad ng laparoscopy, etc. Kung confined ang patient, puedeng ma-cover siya as part of the overall process of diagnosis and treatment. Ask mo na lang sa hospital.
    Meron akong nakitang magnetic resonance guidance for needle placement at magnetic resonance for visceral tissue ablation — 8,020 ang coverage amount.

  870. hi i would like to ask if the MRI is included in philhealth benefits?

  871. Hi Mercy, nabasa ko nga yong rule na yan sa circular ng new Case Rate list na lahat na ngayon ng filing ay dapat hospital ang mag-file with Philhealth, at wala nang member’s direct filing sa Philhealth, kasi lahat ng medical conditions ay under Case Rate na. Hindi man lang kayo tinanong kung merong Philhealth ang patient? Or sana na-mention nio ang Philhealth.
    Go to Philhealth and ask, kasi meron namang exception, bukod sa new ruling pa ito, so dapat hindi pa strict ang implementation. Sa Philhealth website, walang announcement sa homepage, at ang instructions on Direct Filing/Reimbursement ay andon pa sa website.

  872. Hi aubrey, yes, your baby is already covered as your dependent. Kinuhanan ka ba ng another claim form 1? For your baby?. You can use the hospital-issued birth certificate for filing. Ang coverage, depende sa main diagnosis ng baby at kung puedeng ma-cover din ang secondary condition. Hindi ko sure kung puedeng ma-combine ang neonate conditions niya plus moderate pneumonia or vice versa. Ask na lang.

  873. Hi,is it true na di ka na puedeng mag claim ng philhealth benefit once na nakalabas ka na ng ospital? Na surgery kasi brod ko sa kidney ng biglaan and he spent more than 115,000.00 pesos and now that he is trying to claim his benefit,(he is his own beneficiary) he was told na wala syang makukuha dahil kailangan nag file daw sya ng claim while he was in the hospital. Please enlighten me. Salamat po!

  874. Hi,may mga katanungan lang po ako. Nasa Navy brod ko for over 10 years, single sya. He underwent laser surgery sa kidney nya last week. Biglaan syang naopera dahil as soon as na nagpa doktor sya and underwent ct scan,suggestion ng doktor i surgery sya right away as his left kidney was getting big. Bale sa ospital sa Bikol sinimulan yung ibang processing such as paglagay ng tube and other stuff but the laser suggery was performed in Alabang, Mla. He spent P115,000.00 sa both hospitals. Now that he is trying to claim his philhealth benefits, they said na may bago raw implementation ang philhealth na kailangan mag claim while they are in the hospital. Ngayon wala syang makuhang benefits from philhealth kahit singko dahil dapat nag file sya habang nasa ospital. Di ko ma maintindihan, a.) I don’t think na inform sya about sa bagong implementation otherwise gagawin nya yun, b.) biglaan ang surgery, hindi naman nya magawang mag file ng mga papers habang nasa ospital. Please help! Salamat po.

  875. Hi woukd like to ask if how much kaya mababawas sa philhealth ng baby ko. I gave birth last jan 20 2014. and naiwan si baby sa nicu due to premature sya and nadiagnose na may pneumonia si baby ko. Nabasa ko po kasi na 15k deduction pag mild pneumonia. Kasama na ba si baby ko sa benefits na ito ng philhealt. Salamat po

  876. Hi james, nakita ko sa new Case Rate list, 18k ang coverage (8400 for hospital; 9600 for PF) pag walang malignancy. Pag merong malignancy, coverage is 30,300, Ask your OB.

  877. bilateral oophorectomy, is it covered by philhealth? or does it have a case fixed rate? or is it just a simple ceasarian surgery that has a fixed rate? salamat po,

  878. Hi anna, 200 pesos per month na ang Philhealth for OFWs and other individual payors. Kapag age 60 na at nakapagbayad ng at least 120 contributions sa Philhealth, eligible na for Lifetime Free Philhealth membership.

  879. ask ko lng po mgkano po ang bbyaran ng ofw monthly?meron po ba hanganan ang pgbayad ng contribution sa philhealth? until what age po? salamat po sa pg reply sa mga katanungan namin. god bless

  880. Hi marj, dapat magpa-prenatal ka sa lying-in kung saan mo planong manganak, kasi required na meron kang prenatal sa kanila. Puede lang mag-Philhealth member kapag di pa kayo kasal.

  881. Gudam mam! ask ko lang po about sa policy ng mga lying in clinic sa pag avail ng philhealth. I gave birth po kc sa 1st baby ko 2010 dpo namin nagamit ng husband ko philhealth nya dpo kami kasal. May2011 naoperahan din po ako n gov appendectomy and dpa rin po nagamit philhealth,dpa rin po kasal.Hs This time po im on my 2nd trimester ng pagbubuntis

  882. Hi lourdes, that’s the Philhealth benefit payment notice. If your HMO handled everything, and you did not pay any amount to the hospital, just disregard the notice. That means Philhealth paid its share of the shockwave cost, and your HMO paid the rest. But keep the Philhealth notice for record/reference purposes.

  883. good mrning! i have undergone a shockwave procedure in july 2013, aside frm philhealth i also also use my healthcard provided by our after almost 6 mos i rcv a mail frm the hospital showing my philhealth pin # the computation of my hospital bills including professional fees .can u tell me what this is and how does philhealth work w/ healthcards?thanks!

  884. Hi anna, puedeng-puede, gusto ng Philhealth yon, merong additional income sila. Ayaw mong gamitin ang pagka-dependent sa husband? Or gusto mo kasing dependent mo ang parents mo aged 60 years old or above?

  885. ask ko lng po na pwede po bang mg member ako ng philhealth? kahit ang asawa ko ay member na? 10 yrs na ako ditto sa ibang bansa.

  886. Hi Mercy, sorry this website is not owned by Philhealth. Sorry I don’t have access to Philhealth’s database.

  887. Hi alma, nagbayad ka na ba ng OEC sa POEA? If yes, member ka na ng Philhealth, kasi nakasama sa Philhealth sa list ng babayaran sa OEC, at puede nang gamitin ng asawa mo. Give a copy of your OEC receipt to your husband and a copy of your ID. Your husband gets your MDR and claim form 1 from Philhealth. Present Philhealth receipt, MDR and claim form 1 to hospital.