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

August 17, 2011 · Filed Under insurance, philhealth 

Last September 1, 2011, Philhealth started implementing its policy of paying fixed rates or fixed amounts to accredited hospitals and clinics for 11 medical cases and 11 surgical cases under its reimbursement scheme called Case Rates Payment.

If we count 9 case rates payment packages implemented since 2003, there are now 31 medical and surgical cases paid by Philhealth under its Case Rates Payment scheme. Other cases are paid under the regular Fee-for-Service scheme.

The fixed Philhealth payments are made directly to the hospitals or clinics. The fixed Philhealth payment is deducted from the total hospital bill and the balance will be paid by the patient.

Philhealth said that the Case Rates basis of payments for SURGICAL CASES  is applied to cases managed at Levels 2 to 4 hospitals (bigger hospitals), with certain exceptions.

For sponsored members and their dependents, the No Balance Billing Policy will apply when they are confined in government hospitals or clinics. It means the Philhealth payments will be adequate to cover their expenses for these 22 medical and surgical cases and they don’t need to pay anything. In cases where patients are asked to buy certain drugs or supplies, they will be reimbursed.

These are the selected medical and surgical cases and the fixed amounts that Philhealth is going to pay to hospitals or clinics, implemented for patients admitted starting September 1, 2011:

MEDICAL CASES

Medical cases Case Rates in Pesos
1.  Dengue 1
Dengue Fever and DHF Grades 1 and 2      8,000
2.  Dengue 2
DHF Grades 3 and 4 16,000
3.  Pneumonia 1 – Moderate Risk 15,000
4.  Pneumonia 2 – High Risk 32,000
5.  Essential hypertension 9,000
6.  Cerebral infarction (CVA I) 28,000
7.  Cerebro-vascular accident
hemorrhage (CVA II) 38,000
8.  Acute gastroenteritis (AGE) 6,000
9.  Asthma 9,000
10.  Typhoid fever 14,000
11.  Newborn care package (NCP) 1,750
SURGICAL CASES

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
Note:  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.
 

Comments

294 Responses to “Philhealth Benefits — Case Rates Payments for Certain Medical and Surgical Cases”

  1. Nors on February 9th, 2013 4:08 pm

    Hi jill, sori hindi ko maestimate, kasi maraming variables, at hindi under Case Rate ang bypass. More likely na mas malaki pa ang mahingi nio from PCSO. Kasi merong limits ang Philhealth coverage for room, OR, medicines, PF, and lab. Tingnan mo itong chart na ito: http://www.philhealth.gov.ph/members/employed/coverage.html

  2. Nors on February 9th, 2013 4:53 pm

    Hi jhen, I suggest kausapin mo muna yong doctor kasi, ang policy ngayon ng Philhealth ay pinapa-abrub muna ng Philhealth ang cataract request bago gawin ang procedure. Expensive ang St Lukes, so malamang mas malaki ang bayaran mo kesa yong 16k or 32k (depende sa case) na mababawas.

  3. evie ruth on February 14th, 2013 8:51 pm

    gud day, can I refund from philhealth even if one month already passed since my child was confined. I paid cash because the hospital is not yet covered by Philhealth.

  4. Nors on February 15th, 2013 5:38 am

    Hi evie, do you mean the hospital was not Philhealth-accredited when your child was hospitalized? And now, it is accredited? I’m not sure if you can claim. But if the hospital fills up and signs the claim forms, then perhaps you can try filing your claim. You have 60 days from date of discharge to file your claim.
    But if the hospital is not accredited even up to now, sad to say, you cannot file a claim. It should be Philhealth-accredited.

  5. Paola on February 15th, 2013 1:28 pm

    Hi, My daughter was hospitalized this month, Her final diagnosis is Pneumonia with asthma component, It is included ba in Pneumonia 1 which has a case rates of P15,000? last time she was admitted in a different hospital with the same finding, we availed of the whole P15,000 but now we got only about half, as shown in the deduction in our billing. can we file a reimbursement for this?

  6. Nors on February 15th, 2013 4:42 pm

    Hi Paola, did you submit Philhealth papers to the hospital? and is there already Philhealth deduction in your bill? If there is, then that means the hospital will file a claim. There should be only one claim for every case, so I suggest you wait for the benefit payment notice from Philhealth, and then if you see that Philhealth paid 15k, you go to the hospital and ask for your refund. Keep your receipts (orig and xerox). We can’t know what illness code the doctor wrote in your claim…as there’s no pneumonia coverage lower than 15k under the Case Rate list. You can also ask the hospital’s Accounting/Collection why your deduction was only such amount as you got.

  7. Lilane on February 17th, 2013 8:23 am

    I will just ask how much will be deducted if i will undergo tonsillectomy?

  8. Nors on February 17th, 2013 5:37 pm

    Hi Lilane, tonsillectomy is not in the Case Rate list, so there’s no fixed fee amount. Philhealth will pay part of your bill, up to the Philhealth limits for room, medicines, lab, PF, OR, depending on hospital and doctor category, and illness severity. Here are the tables, if you like to see.
    https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1

  9. Patrice on February 21st, 2013 9:46 pm

    Good day! My child will undergo a methylprednisolone treatment for 3 days in a private hospital (philheath accredited) because she was diagnosed with lupus with nephritis class IV. May I ask what case type this falls under, please? Thanks much!

  10. Nors on February 22nd, 2013 6:50 am

    Hi Patrice, lupus or methylprednisolone treatment is not in the Case Rate list, so it will be paid under the old scheme called Fee-for-Service. It will be categorized and covered based on limited benefits for drugs, room, medicines, and PF https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1

  11. leonimar on February 27th, 2013 2:31 pm

    helo,may claim status report akong nakuha from philhealth,nakalagay dun ung amount ng 2 checks amounting 46 plus and 25 plus,tapos ung 46thou e nadeduct dun 10500 para sa hospital bill,ung 25 thou eh 4500 deduct para sa doktor,saan po napunta ung excess ng cheke.leoni po from, cagayan valley

  12. Nors on February 27th, 2013 6:21 pm

    Hi leonimar, did you pay any amount to the hospital? If you did not pay anything, because everything was charged to Philhealth, all the excess Philhealth payments will go to the hospital.
    But if you paid the hospital, you can ask for refund. Have copies of your receipts and your notice from Philhealth.

  13. jelyn falcasantos on March 3rd, 2013 10:44 am

    I would like to know if how much will philhealth shoulder for my husband’s thyroid radioactive procedure? he had one,two years ago.but im n0t sure if he will be spending the same,specially now with your case rates. thank you.hoping for a favorable reply.

  14. Nors on March 4th, 2013 5:00 am

    Hi jelyn, I’m not sure if that procedure falls under radiotherapy, which has a coverage of 3k pesos per session, so please ask your doctor.

  15. jhon tonel feliciano on March 4th, 2013 11:05 am

    mgandang araw po.. isa po akong ofw dito sa riyadh ksa. nais ko pon sa inyong idulog ang aking problema dahil nsa ospital ang aking anak na may sakit na UTI at neumonia.sabi po ay covered daw po ng philheath ko ang mga anak ko.. bkit po ng sumangguni ang aking anak ay hndi daw po nka tala sa knila ang mga beneficiary ko ngunit npkatagal ko na pung ng karoon ng philheath noon pa at ktunayan po ay last year umuwi ako ng pilipinas at ng renew po ako sa POEA KSMA SA PGBAYAD NMIN ng OEC. overseas employment cert. nais kopo sana malaman kung ano po ang dapat gawin ng aking mga anak… mraming maraming salamat po.. ang aking anak n nsa hospital po ay nagngangalang IRSH FELICIANO LAYAG.. pki tulungan naman po kaming mag aama.. mraming maraming salamat po.. hihintayin ko po ang inyong tugon..

  16. Nors on March 4th, 2013 2:31 pm

    Hi Jhon, your child can still avail of your benefit even if he or she’s not written in your MDR as your dependent. You ask your wife to present to the hospital your child’s birth certificate (xerox copy for submission, and original copy for checking), copy of your OEC receipt and get MDR from Philhealth. Ask your wife to bring her IDs and your marriage certificate so she can get your MDR from Philhealth. You can email her an authorization letter authorizing her to transact with Philhealth (some do not require this, but some require it). You can scan your OEC, then email to your wife, so she can print it. Another option is to request for certification of eligibility from Philhealth, if your OEC is not clear.

  17. angee on March 16th, 2013 3:11 am

    Hi Ms. Nors, OFW po ako and I decided to give birth sa pinas,my problem is kakahulog ko lng po ngyon march 8 ng 1200 sa Iremit for the coverage of march 2013 to feb 2014, I would to ask if magagamit ko ba philhealth ko this coming July? and if ever magamit ko what requirements should I prepare? nabasa ko po kc sa mga comments about OEC, can I use my foreign ID and Passport cause I don’t have an OEC and copy of contract.

    Thanks and regards…

  18. Nors on March 16th, 2013 7:42 am

    Hi angee, yes, you can avail of the benefit because your premium receipt reflects March 2013 to Feb 2014 and your due date is within these dates. Yes, you can use your foreign ID and passport. Besides, you paid your premium at IRemit, so that means you work abroad as OFW. Keep your prenatal ORs (at least 1500 total) so you can avail of the prenatal benefit of 1500 — submit with your claim forms (MDR from Philhealth, premiums receipts – xerox and orig, your IDs, claim form 1 – one for you and another for baby. If you can get a Philhealth ID, it’s better.

  19. Joylin on March 17th, 2013 12:37 am

    Hi Ms. Nors, I am an OFW and would inquire if dog bite is covered by phil health my father was bitten by our dog yesterday 15th march 2013 please advise whether he can use my phil health as my beneficiary, they paid almost 8K according to San Lazaro hospital my father needs to come back 6X more in the hospital for some other treatment, is the amount paid by my father can be refunded???Also please advise whether they can use my phil health???Thanks!!!

  20. Nors on March 17th, 2013 12:54 am

    Hi Joylin, is your father 60 years old or older? If he’s younger, sorry, he cannot yet be your dependent. If he is, yes, there’s coverage for animal bites, but the coverage is only 3k. Yes, San Lazaro is accredited. Ask your family to inquire about it at San Lazaro.

  21. Joylin on March 17th, 2013 1:44 am

    Hi Ms. Nors thank you for your response. My father is 72 years old. what are the requirements in availing this benefits. They already paid 8k can they refund the amount covered????

  22. Nors on March 17th, 2013 11:06 pm

    Hi Joylin, documents required: your MDR, premium payment receipt (keep your copy), your birth certificate, proof of your father’s age (can be senior citizen’s ID or birth cert), your authorization letter authorizing your mother or sibling to sign claim forms in your behalf, copy of your IDs, IDs of mother or sibling. The 3k can be applied for the next treatments; they need to ask San Lazaro about Philhealth processing there.

  23. milagros marcelino on March 18th, 2013 9:50 pm

    cover po ba ng philhealth ang check-up ng doktor sa opd?

  24. Nors on March 19th, 2013 7:18 am

    Hi milagros, sorry po, check-up at opd is not covered by Philhealth. Only outpatient surgery and hospitalization

  25. cristina on March 19th, 2013 1:27 pm

    good day! my father is 60 years old and was confined in a philhealth accredited hospital. His medical case is pneumonia 1 and we dont know if we can use the philhealth benefit of my sister. She started working last december 4 2012 until now. My question is can we get any benefit from philhealth or any refund? thank you.

  26. Malou on March 19th, 2013 4:04 pm

    Hi Ms. Nors, my mother was diagnosed with tumor in ovary. She will undergo operation after we got clearance from endocrinologist for hypertension and diabetis. She is 80 years. I’m married with 3 children, my mother is one of my dependent. Can we use my philhealth even if i have 2 single sisters na dependent nila ang mother ko. Is there any difference with the rates since I’m privately employed while my sisters are government employees.

  27. Nors on March 19th, 2013 4:28 pm

    Hi cristina, if your sister’s firm was able to pay her Dec premium, plus premiums for Jan and Feb, then she can file a claim for your father. Your sister presents her birth certificate (orig and xerox) either to Philhealth for MDR update, or to hospital (if there’s no more time to update) plus proof of your father’s age (his birth/baptismal cert or senior citizen ID). Also needed: certificate of premium payments with OR nos. from employer, claim form 1 signed by employer, Philhealth ID or valid ID. I’ve read from comments here that suspected pneumonia is not covered; but I hope your father’s case gets covered.

  28. Nors on March 19th, 2013 9:42 pm

    Hi Malou, your mother will receive the same benefits, whether your Philhealth is used or that of one of your sisters…
    Prayers for a successful surgery…

  29. Vic on March 21st, 2013 11:07 pm

    Hi ms Nors, I’m planning to undergo tonsillectomy at PGH ambulatory (same day surgery/no confinement). the fee estimated 25 to 30k. How much or what percent could I get when I use my Phil Health and what should I filled to get my refund.I already ask the doctor but doesn’t know the exact computation. thank you…

  30. Nors on March 23rd, 2013 3:55 pm

    Hi Vic, your doctor can’t give you the exact amount because the coverage amount for tonsillectomy is not fixed, unlike those procedures under Case Rate scheme. You will get limited coverage for drugs, OR, lab and PF under the old fee-for-service scheme. https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1 Documents: Claim form 1, MDR, Philhealth ID or valid ID, premium receipts or cert of premium payments from employer if employed. http://www.healthphilippines.net/2012/03/how-to-file-a-philhealth-benefit-claim-for-reimbursement/

  31. marcee on March 25th, 2013 12:19 pm

    hi. i am to undergo an outpatient mole surgery next week at pasig city general hospital and according to the nurse,all i have to pay is a minor fee of P330. she also asked me to buy some supplies and anesthesia for the surgery. i would like to request a mole biopsy after the operation. would any of these be refunded by philhealth?

  32. Nors on March 25th, 2013 10:31 pm

    Hi marcee, outpatient surgery can be covered by Philhealth; but ask the nurse about how you go about it. Just bring your documents. Usually outpatient biopsy is not covered because it’s a diagnotic procedure.

  33. jeanette saluba on April 2nd, 2013 12:40 pm

    hi! my mother undergo surgery at perpetual succour hospital in cebu in sept 2012..i supposed it was mastectomy, but philhealth rep said it was not so the case rate did not apply (22k)…so be it, we just paid the bills accordingly as presented. however, just this week i received the notice of payment from philhealth that the case was mastectomy and perpetual succour hospital was paid 22k.when asked for refund, billing incharge informed me that only the excess paid for other bills except the PF will be refunded, that is 60% of 22k = php 13.2k, we will be refunded 6k only since philhealth initial deduction was 7.2k, and that is OK. however there is no refund on the doctor’s PF. total PF billed was at 37,414.86, with initial philhealth deduction/benefit at only 7.772k, thus we paid, Php29,642.86. the philhealth notice informed us that PF is php 8.8k that is, 40% of the 22k case rate amount, therefore, we paid an excess of 8.8k – 7.772k = php 1,028.00 which i expect to be refunded to us, but which perpetual succour hospital declined to give. any suggestion on this. thanks.

  34. Nors on April 2nd, 2013 8:35 pm

    Hi jeanette, it’s too frustrating to know about what that Philhealth rep told you. Was she lying so you’ll pay in cash? Or was she plainly inefficient? How can she say it’s not mastectomy and then they file for mastectomy? Whew! The hospital should refund you 1,028, because Philhealth paid them 22k. And I’m not sure how you can pressure the hospital to refund you that amount — Try asking the hospital “If I go to Philhealth and ask for an order for you to refund me 1,028, will you give the refund?” By the way, you write well. Best regards.

  35. shinahlou on April 7th, 2013 8:47 pm

    Tlga bang Ang claim check ng philhealth e manggaling p s Capitol ng naval,Dba dapat sa philhealth thru mail or I-claim mismo sa philhealth office Ang cheQ?kc (C-Sections) delivery ako at inasikaso ko last dec2012 ang philhealth ko. then lately lang lumabas Ang printed statement ng philhealth . Nung kinuwenta na NSA 3thou LNG Ang claim ko.of course nakkgulat tas ang explain nila kinukuwenta p daw sa naval hospital tas approval galing p sa kapitolyo.nakakawindang naman ang process d2.hindi aq baguhan sa philhealth at unfair p dun sobrang Laki ng ginastos namin at sa labas naman Ang gamot,doctor’s fee at gastusin namin.mas mgnda p cguro s city at private hospital nalang fair p cguro ang claim ko.dito Ang labo e..kaya dis month i verify ko nalang to s manila.advnce naman at yearly ang bayad ko ng philhealth then unfair Ang claim ko.dito ko LNG s naval na experience yan.

    gsto ko LNG ishare at no offense sa tatamaan ha gusto ko lang kc maintidihan ganun b talga dito.?

  36. mylene on April 7th, 2013 9:05 pm

    hi Ms. Nors good evening,.i would like to ask if Ct scan,.ultrasound,room and other laboraty are covered by the Philhealth for my dependent (my father age 61 yrs old) if so ,how many percent..thanks..pls kindly reply

  37. Nors on April 8th, 2013 7:20 am

    Hi mylene, yes, part of the costs of those things will be covered if he is confined for more than a day, and the disease is diagnosed and there’s treatment. I hope there’s a diagnosis and effective treatment.

  38. Nors on April 8th, 2013 7:28 am

    Hi shinahlou, is this Naval in Cavite? Because you mentioned kapitolyo. Or is there a Naval hospital in Cebu? Your IP address is Cebu.
    Same with you, I’m also not familiar with how some government hospitals are processing Philhealth claims, but there have been several commenters here who have described the same situation as yours. I’ve realized that the finances of some local hospitals are controlled by their local governments, even the accounting work, so Philhealth refunds are coursed through these local governments.
    In other government hospitals in the provinces, where relatives have been confined, like the regional hospital in La Union and the hospital in Bio, Tagudin, the Philhealth process for these relatives have been problem-free.
    I hope you can resolve your refund when you go to Philhealth and ask. best regards

  39. Doods on April 8th, 2013 4:56 pm

    Hello po, just want to inquire kasi po yun father ko na stroke pag land nila sa thailand last month. Naconfine po siya ng 1 week sa hospital sa thailand tapos inuwi po. Naka confine pa rin po siya sa hospital ngayon dito sa Pinas. Pwede po bang ireimburse kahit portion po nung gastos sa Thailand?. Tsaka po matagal na pong di nahuhulog Papa ko sa philhealth pwede po ba namin, na add ko na oi siya as dependent ko pero dapat daw pa close daw muna yun account niya. Pwede po ba yun? 62 years old na po pala Papa ko.Thank you po.

  40. mylene on April 8th, 2013 6:23 pm

    hi Ms,Nors good pm…My father(age 61) is now undergoing for 2 decho w/ doppler study,.carotid duplex scan and after that procedure they do endoscopy they are asking for 20k as of now,the question is how philhealth can help for this?

  41. Nors on April 9th, 2013 10:46 am

    Hi Doods, ask your father to sign his letter asking Philhealth to cancel his membership because he’s already 62 years old and to register him as your dependent. Later on, he can apply for free Lifetime membership if he had accumulated 120 monthly payments to Philhealth.
    About your expenses in Thailand, there’s a Philhealth rule called single period of confinement, where Philhealth do not cover the next confinement for the same illness within 90 days. Are the reasons for the 2 confinements the same? So if you make a claim for the Thailand confinement, your claim for this current hospitalization might be denied. Please ask Philhealth personnel to be sure.

  42. Nors on April 9th, 2013 11:31 am

    Hi mylene, I think the procedures you mentioned are all diagnostic procedures, so I hope they arrive at a diagnosis and perform a successful treatment, because I’ve read that Philhealth covers part of the expenses only for cases where there’s a definite diagnosis and treatment.

  43. Carla on April 10th, 2013 3:39 pm

    Hello po mam, ask ko Lang po, na D&C po ako last march 31 2013 po at ang bill ko po ay umabot ng 70k peso sa st. Luke’s po. Tanong ko Lang po kung sa tingin nyo po kaya mga magkano ang cover ng PhilHealth po???kasi now po need ko nalang po yung sign from the doctor ilang beses narin po kasi akong pabalik balik dito sa st. Luke’s to see the doctor to sign kaso lagi pong wala :(

  44. Nors on April 10th, 2013 11:11 pm

    Hi Carla, you can refund 11k (Philhealth coverage: 6,600 for hospital expenses, and 4400 for PF or doctor’s fee). Hope you see the doctor soon.

  45. barbara pea on April 12th, 2013 6:43 pm

    Hi Ma’am Nors, I’m planning to undergo a hemmorhoidectomy in NKTI this April. I cannot seem to find what case type it is. Am I on the right track looking at the link:Revised Inpatient Care Benefits
    The following are the maximum allowances or ceilings to beapplied per single period of confinement** effective April 5,
    2009 admissions onwards? what case is hemmoroidectomy? ABC? Thanks so much

  46. Nors on April 12th, 2013 9:32 pm

    Hi barbara, you’re right, hemmorhoidectomy is not included in the Case Rate scheme. It will be covered based on the fee-for-service scheme –yes, that inpatient chart you’re looking at. You get coverage for OR, meds, PF, room, lab up to the limits, depending on the severity of the illness and hospital category. best regards

  47. galeb on April 24th, 2013 3:12 pm

    Hi. just want to ask if we can still avail the philhealth benefit for pneumonia.

    May sister was confined and AlReady availe the the benefit under pneomonia1 (moderate risk). but after a day we come back a gain in the same hospital but this time my sister was diagnosed with liquids in her lungs. Immediate surgery was conducted yo remove the luquids in her lung… in my understanding its under pneumonia2 highrisk?

    In this case can we still avail benefits? base from ur philhealth representative we cannot because we ALREADY availed the benefits of pneumonia1 same thing “LANG DIN DAW if pneumoniA2″. we can avail same benefits after 3months.

    Is this true? Is it fair?…

  48. Nors on April 24th, 2013 9:20 pm

    Hi galeb, yes, that’s true. Yes, it’s not fair. They call that single period of confinement. The 2nd or 3rd confinement is not covered if it is the same illness within 90 days. I’m puzzled that the hospital was not able to see the developing fluids in her lungs during her first confinement. But you can ask for deduction for the room and board (every member has an allotment of 45 days per year for room and board) and the rest of the 15k coverage if the 15k coverage was not used up in the first confinement. I don’t know if this is possible, but if the first claim was not yet submitted to Philhealth, ask if you can pay for the first confinement (if it is cheaper) and then you file for Philhealth coverage for the 2nd confinement (if it is more expensive).

  49. galeb on April 25th, 2013 1:45 pm

    Hi again Ms. Nors.

    The issue here if Pneumonia 1 or 2 is the same why put 2 different category in Sickness benefits? Pwede naman High risk nalang diba? Thats my arrugement po mam.

    Yes logically its the same illnes, but i think the manner why it is been done separately is because a patient CAN avail the same bendefits without the governing rules of “single illness requirements”. That’s is base to my understanding po…

    In our case we already maximize the Pneumonia 1 benefits (15k) and now because this another confinement plus surgery our case was automauca it will abviously put us into category Pneumonia 2 wich has a bigger subisidy (32k). and this all happens in a matter of 1week.

    sorry for too much query mam…

  50. Nors on April 25th, 2013 9:07 pm

    Hi galeb, it’s okay to argue your point. I really wish you can refund. The phrase used by Philhealth is “the same illness”. Pneumonia 1 and pneumonia 2 are the same pneumonia; it’s just that they differ in the severity. Anyway, I suggest you go to Philhealth and ask. Or if the hospital refuses to deduct, and if you decide to try, ask the hospital to fill up the claim forms and that you’ll be the one to file with Philhealth for refund. best regards

  51. Florenio Pereyra on April 26th, 2013 12:03 pm

    Good day,I just wanna ask regarding the case of my wife having major operation,so called vitrectomy,we have to pay 200,000.00 pesos,Was done in Cardinal Santos medical center,in what category the case of my wife falls?thanks.

  52. Nors on April 26th, 2013 2:59 pm

    Hi Florenio, vitrectomy is not in the Case Rate list, so it will be covered under the old scheme — Philhealth deductions would depend on the category or type of illness/treatment, hospital and doctors. Here is the Fee-for-service Philhealth coverage table for a tertiary hospital like Cardinal Santos.

  53. mary joy on May 11th, 2013 10:26 am

    hi miss nors my father was confined at Uerm hospital last april 30, 2013 and he was discharged on may 4 2013. i paid the hospital bills and other expenses such as medicine, supplies and other laboratory procedures like fbs urinalysis xray and ultrasound in total amount of 16,000 pesos. my father’s case is CVA I. I just want to ask if the total amount will be refunded to me or just a part of it? by the way, my father is a senior citizen and he is.my dependent. thanks.

  54. Nors on May 11th, 2013 7:25 pm

    Hi mary joy, if your doctor wrote in the claim form the code for CVA1 including supporting details and the neurologic exam results are attached, and Philhealth will approve the claim, your 16k can be refunded from the hospital because the coverage for CVA1 is 28k.

  55. Susan Bertillo on May 12th, 2013 5:32 am

    Hi, Miss Nors. My father is 68yrs old he will be undergoing operation for his hernia at Amang Rodriguez hospital. I would like to ask how much will the Philhealth deduct on the bill?

  56. Nors on May 12th, 2013 7:02 am

    Hi Susan, if his case is herniorrhapy, which means surgical repair of the hernia, then the coverage is 21k (12600 for hospital costs and 8400 for PF). Keep your receipts and copies of your receipts (should be in the name of your father) if you are instructed to buy supplies outside.

  57. Mary Joy on May 14th, 2013 10:35 am

    Hi Miss Nors, this is mary joy again. thanks for your reply. I went to UERM hospital and I gave all the requirements that they required me to submit. In my CF2 form the diagnosis of my CVA infarct left internal capsule. Is this under CVA I? I attached The hospital bills receipt which amounting to Php10,672.44 together with the other requirements but they gave it back to me because the philhealth officer there in the hospital said that it’s not needed. My other expenses receipts was only attached there in total amount of 6,000.00. Why they did not include my hospital bills which I paid in full? My father was confined in their Neuro ward which is a charity ward.is that proper Miss Nors? thanks hope you reply soon.

  58. Mary Joy on May 14th, 2013 10:56 am

    RE: hi miss nors my father was confined at Uerm hospital last april 30, 2013 and he was discharged on may 4 2013. i paid the hospital bills and other expenses such as medicine, supplies and other laboratory procedures like fbs urinalysis xray and ultrasound in total amount of 16,000 pesos. my father’s case is CVA I. I just want to ask if the total amount will be refunded to me or just a part of it? by the way, my father is a senior citizen and he is.my dependent. thanks.

    FOLLOW – UP QUESTION

    Hi Miss Nors, this is mary joy again. thanks for your reply. I went to UERM hospital and I gave all the requirements that they required me to submit. In my CF2 form the diagnosis of my CVA infarct left internal capsule. Is this under CVA I? I attached The hospital bills receipt which amounting to Php10,672.44 together with the other requirements but they gave it back to me because the philhealth officer there in the hospital said that it’s not needed. My other expenses receipts was only attached there in total amount of 6,000.00. Why they did not include my hospital bills which I paid in full? My father was confined in their Neuro ward which is a charity ward.is that proper Miss Nors? thanks hope you reply soon.

  59. Mary Joy on May 14th, 2013 11:06 am

    hi miss nors, mary joy again, sorry for the wrong diagnosis i mentioned. the diagnosis of my father is CVD INFARCT, LEFT INTERNAL CAPSULE. NOT CVA INFARCT. IS THAT UNDER CVA I? THanks

  60. Nors on May 14th, 2013 11:19 pm

    Hi Mary Joy, sorry I’m not a doctor so I can’t accurately answer your question. I’ve read though that CVD is more complex than CVA, or that CVA is one of the signs of CVD. If these 2 are considered differently by Philhealth, then your father’s case will be under the fee-for-service scheme (the old scheme). Under this scheme, there are benefits for meds, lab, OR, PF, room and board with maximum limits, depending on type of hospital, severity of illness and specialization of doctor. These are the charts of benefits under the fee-for-service scheme< \/a>

  61. Mar on May 16th, 2013 10:08 am

    just want to inquire on how much is the maximum amount that philhealth will give if you are hospitalized twice or thrice within a 90 day period.

    for example: first confinement is 7 days and after a month again was confined for 4 days.
    is the benefit per confinement? or they will consider the total number of days in giving the second confinement benefits? thanks.

  62. Nors on May 16th, 2013 10:41 pm

    Hi Mar, the benefit amount would depend on the ilnesses and severities. But if a member is hospitalized for the same illness within 90 days, the 2nd or 3rd or subsequent hospitalization will not be covered. If the illness is covered under the old fee-for-service scheme, only the room and board will be covered in the 2nd confinement (because each member is allocated 45 days of room and board per year). But if the illnesses are different, for example, pneumonia 1 and then dengue 1 within 90 days, then both are covered.

  63. Loisa on May 20th, 2013 3:12 pm

    Good day po. Ano po procedures pag gagamitin ko philhealth ng husband ko na nasa ibang bansa ngayon. Need ko po kasi mag pa appendectomy. Ano po mga documents ang kailangan ko ihanda? Thank you po

  64. fely on May 21st, 2013 12:17 pm

    My mother was admitted last week due to abdominal pain.She was discharged after 24 hrs.After one she felt body weakness and loss of appetite so she was admitted again.my mother is 70 yrs old age.During her stay to hospital my mother suffered again abdominal pain.According to philhealth staff of the hospital they will not covered the second admission of my mother.Im an OFW more than 20yrs contibuting philhealth.Pls help me what to do.thank you.

  65. fely on May 21st, 2013 12:50 pm

    what i mean in my first question is my mother re admitted after one week.thak you

  66. Nors on May 21st, 2013 7:25 pm

    Hi Loisa, if emergency, you can bring your MDR, marriage certificate (if MDR is not updated), ID, claim form 1, premium payment receipt (for OFWs, hospitalization date should be within receipt’s validity dates). But if still possible, update at Philhealth your husband’s MDR and to register yourself as dependent. Bring your ID and marriage certificate. Helpful info for OFW dependents.

  67. Nors on May 22nd, 2013 3:34 am

    Hi fely, it’s sad, but that’s one policy of Philhealth — the rule on 90-day single period of confinement. This means that the 2nd or 3rd (and so on) confinement of the same person due to the same illness within 90 days is no longer covered. But the rule also says that the room and board can be covered, so ask if they can deduct the expense for the room and board (each member is allotted 45 days per year). And also the discount for senior citizens for medicines.

  68. Louie on May 31st, 2013 4:46 pm

    Ask ko lang po kung magkano ang ma less using philhealth card for tonsillectomy procedure ito po yong estimate 35k for ENT 17k for Anesthesiologist 15k for Hospitalization and 5k for Pedia bigyan nyo po ako kahit approximate lang. salamat

  69. Nors on June 1st, 2013 7:54 am

    Hi Louie, sorry I can’t give you an estimate because tonsillectomy is not in the Case Rate list. Your case will be covered under the old scheme, which is sometimes better — Merong mga maximum amounts for meds, docs, OR, lab and room/board, depende sa hospital category, doctors’ specialization and gravity of illness. Tingnan mo itong tables na ito: Fee-for-Service

  70. alvin on June 7th, 2013 3:30 pm

    hi, tanong ko lang po kung dapat ba na makipag ugnayan muna ako sa philhealth bago ko pasimulan ang HEMODIALYSIS ng tatay ko? kasi po 4k po bawat session ng dialysis, now the question is, do we need to have 4k everytime na gagawin ang session or automatic na ibabawas nalang po yung dialysis fee sa philhealth? by the way sa NKTI po namin planong gawin ung dialysis..maraming salamat po

  71. Nors on June 7th, 2013 9:17 pm

    Hi alvin, it’s better if you find a hemodialysis center that deducts your benefit immediately so that you don’t have to pay cash. There are dialysis centers that offer Philhealth packages. Bring your MDR, Philhealth receipts and IDs. Yes, going to NKTI first is good.

  72. angelyn on June 16th, 2013 10:39 pm

    Hi good evening. Just want to ask how to update my name in Philhealth? I want to use my maiden name after an annulment. What are the documents need to bring? Can I ask someone to update it for me since I am working abroad? And after updating and paying, am I immediately entitled for the benefits? I am planning to have ESWL in Asian Hospital 2 weeks from now, will it be covered? Hoping for your response, thank you so much. Godbless.

  73. Nors on June 17th, 2013 8:39 am

    Hi angelyn, yes, you can authorize someone to update your Philhealth record with: your Philhealth no., judgment of annulment (orig and xerox), copy of your ID, authorization letter, representative’s ID.
    Since you’re working overseas, you can register as OFW and use Philhealth immediately. Send your rep a proof of your work overseas, such as work visa, OEC, job contract, or foreigner’s ID. Rep should check Overseas Filipino Worker in the Membership Category portion. You’ll pay one year in advance, so that the validity dates in your receipt with cover the date of your hospitalization.
    Only a portion of ESWL is covered, so you will pay the rest. It’s always good to ask first the hospital/doctor the total package cost and the possible Philhealth deduction amount. God bless din.

  74. angelyn on June 17th, 2013 7:49 pm

    Thanks for the reply. The original copy of the court order for the annulment is with me. Will the xerox copy and other supporting documents will do?

  75. Perlita Rodriguez on June 17th, 2013 10:06 pm

    Hi Maam,,
    My mother who has retired as a public school teacher 14 years ago needs a knee arthroplasty .Is she covered by Philhealth? How much would Philhealth cover for the surgery? Thank you.

  76. Nors on June 18th, 2013 10:19 am

    Hi Perlita, sorry I can’t give an estimate because knee arthroplasty is not in the Case Rate list. It will be covered under the old scheme. Fee-for-Service scheme. Yes, she is covered as your dependent if you’re an active Philhealth member and she’s 60 years old or older. Or if she is a free Lifetime Member (has contributed 120 contributions to Philhealth).

  77. Nors on June 18th, 2013 10:20 am

    Hi angelyn, puede na rin siguro dahil merong supporting documents. Paki-try na lang ng rep mo.

  78. abi on June 18th, 2013 4:40 pm

    ask ko lang po inactive member napo ung husband ko sa philhealth (not paying contribution for 2 years), naaksidente po sya and walang nakuhang benefit..ako po ung pumunta sa philhealth office para sana maging dependent ko, DI PO BA AUTOMATIC UNG HUSBAND NA MAGING DEPENDENT KAHIT WALA PA SA MDR? ginagawa ko po sna syang dependent pro di po daw pwede kasi inactive member napo sya.

  79. Nors on June 19th, 2013 11:25 am

    Hi abi, your husband is your dependent. If you did not get Philhealth deductions, and if you’re still within the 60-day filing deadline, file for refund. At the Philhealth branch, before filing, change first your MDR (fill up Member data Registration Form, Check FOR UPDATING) and register your husband as your dependent by presenting your marriage certificate (orig and xerox). Bring also a letter from your husband asking Philhealth to register him as your dependent because he is no longer active and has been inactive for 2 years (baka ito yong hinahanap. Bring his ID).

  80. angelyn on June 19th, 2013 7:38 pm

    Thank you so much for the reply, you’ve been very helpful. Godbless.

  81. mikka on June 19th, 2013 8:36 pm

    hi po ask ko lng po naconfine po un anak ko sa hospital 4days appendectomy po un case nia ang bill po ng hospital ay 13400 then covered sa philhealth ay 14400.. mareimburse ko pa po ba un mga nagastos ko sa labas na medicine at laboratory.. pls reply..tnx

  82. Nors on June 20th, 2013 1:57 pm

    Hi mikka, yes, you can refund because the case rate coverage amount for appendectomy is higher than your bill. Wait for the benefit payment notice from Philhealth, and then go to the hospital with your ORs (meds bought outside the hospital) and ask for refund. Keep copies for yourself.

  83. mikka on June 20th, 2013 6:15 pm

    tnx for the reply ms nors.. you mean antayin ko un bpn tsaka ko pa lng ipapasa un mga resibo ng laboratory at medicine na nabili nmn wala nman po expired un date ng resibo or how long un reimbursement kc baka pag pinasa ko sa ospital na sabihin sa akin matagal na..nun june
    8 po kmi na confined then na discharged kmi ng june 13.. ty

  84. Nors on June 21st, 2013 5:50 am

    Hi mikka, tama ba ang intindi ko na wala ka nang binayaran sa hospital? Nagtaka rin nga ako bakit higher yong sabi mong covered by Philhealth..13400 ang bill at 14400 ang covered ng Philhealth, so ang inisip ko na lang is PF or additional yong 1k na difference.
    Sinabi kong you wait for the BPN, kasi nasa Case Rate list (see the above article) ang appendectomy, with coverage of 24k. Philhealth will pay the hospital 24k, kahit lower than 24k or higher than 24k ang bill. So usually, inaantay muna ng hospital yong Philhealth payment before making refunds kung merong irerefund.
    Pero sige, baka nga naiiba itong hospital mo, at baka magkamali ako, para sure tayo, puntahan mo yong hospital at mag-submit ka ng copies of your receipts for your refund (dapat meron kang copy for your own use later on).

  85. aye on June 21st, 2013 11:07 pm

    mam nors ask ko lang po nakapagstop po ako ng hulog sa philhealth ko mga 2 months na…pwede ko po ba un mahulugan ulit or di na valid yon?

  86. jhoy on June 27th, 2013 12:29 am

    Hi po,

    Ask ko lang po if how much kaya cover ng philhealth ng brother ko, inoperahan sya sa stomach kasi daw isinaayos mga intestines kc nagkaroon daw obstruction kc nagkadikit dkit daw mga bituka at umikot ng apat na beses. And required kami pa ct scan kaso wala sa loob hospital need outside, marefund po ba yong ct scan sa philhealth?

    Thank you po.

  87. jhoy on June 27th, 2013 1:03 am

    And ms. Nors, if makalabas na po hospital brother ko usinghs philhealth benefits, pwede pa rin po pa kami magreimburse separately ng mga medicines na binili sa labas ng hospital?

  88. jhoy on June 27th, 2013 1:23 am

    Saka po ang mother ko 55 years old na and may philhealth na sya last year wala lang pa hulog at balak ko pong hulugan asap then pwede nya po ba maging dependents yong three menor de edad na kapatid ko. Then father ko bibigyan daw libre philhealth from citihall pero 62 na po age nya alin po mas ok declare na lng sya dependent ng isa sa mga kapatid ko na ma philhealth na?if more than one among siblings ko na may philhealth ang magdelare sa father namin as dependent ibig sabihin within 90 days magkasakit ulit same or not same sickness pwede claim sa ibang anak na may philhealth as dependent?sencya na po di ko masyado kabisado or naiintndihan.

  89. Nors on June 28th, 2013 8:40 am

    Hi jhoy, sorry I don’t know the final diagnosis or main treatment procedure for your brother’s case, but I think it’s not under the Case Rate scheme — yong mga surgery covered ay for other parts of the body. So dapat xerox your receipts, keep your copy, and submit the originals to the hospital so they can include these receipts in the computation and deductions. If patient is already discharged, you can refund these receipts after you receive the benefit payment notice from Philhealth and you see that Philhealth’s payment is higher than what was deducted by the hospital. Pero kung yong Philhealth payment to hospital ay nadeduct naman lahat ng hospital sa bill nio, wala nang marerefund.

  90. Nors on June 28th, 2013 9:01 am

    Hi jhoy, yes, you can continue paying for your mother’s Philhealth, and your mother can declare all her children younger than 21 as her dependents. Bring birth certificates of these children (xerox and orig) when updating your mother’s registration record. About your father: Kung wala pa namang free card from Philhealth, puede namang ideclare siya as dependent of one of his children. Pero technically, puede siyang dependent ng sinuman sa kanyang mga anak. Ang mga benefits ay pareho lang kahit anong type of membership. About the 90-day rule for the same sickness, applicable pa rin sa papa mo kahit marami siyang anak na Philhealth members. If he gets confined for the same illness within 90 days, hindi siya covered or fully covered sa 2nd or subsequent confinements. Yong 45-day allotment per year, 45 days pa rin ang allotted sa kanya kahit he has several children declaring him as dependent.

  91. mona on July 1st, 2013 4:03 pm

    hi. ang question ko po ay tungkol sa katarata ng father ko. kailangan na po kasi siyang maoperahan para umaayos na ang paningin niya. ang history ko po kasi sa philhealth ay nahulugan sya during the time na employed ako august 2010 to january 2011. end of contract na ako nung january at kailangan ko naman gamitin ang philhealth dahil naconfine ang mother ko dahil sa Pneumonia, ang sabi sa akin ng nagpumunta ako sa Philhealth makati ay kailangan kong mahulugan ang January,february at march 2011 para magamit ng nanay ko ang benefits thats why nag file ako as voluntary then nagamit ko na sya, since april 2011 until january 2013 hindi na ko nakapaghulog ulit kahit may trabaho na ko (wala pong benefits dito sa pinagtatrabahuhan ko) February 2013 ako nag start ulit maghulog at binayaran ko na din ang buong year ng 2013 para wala na sanang problema, ngayon ito na ooperahan daw si tatay because of his cataract, ang sabi sa akin nung tumawag ako sa philhealth hotline pag katarata daw dapat 9 months na ang bayad (tama po ba?) eh ang pang 9 months ko ay sa october pa.. grabe talag pa nun.. walang po bang consideration kapag one year naman na yung binayaran mo?

  92. rokezza on July 2nd, 2013 4:45 pm

    good day po..i would like to ask something about ct scan. im suffering po kasi from head numbness for almost a year and i havnt given the chance to go to a neuro because of financial problems. im a member of philhealth and paid it for 5mos. during my employment. actualy its my first job. but unfortunately nag end ako ng contract from it and havnt paid my philhealth for almort 5mos. ask ko lang po kasi my tito ako na nkapag ct scan in bacolod tapos sabi nya wala daw pong bayad bastat philhealth member ka. am i capable po ba to avail this? i need to consult to a doctor badly po kasi hindi ako makahanap na trabaho po dahil palaging sumasakit ang ulo ko. thanks po. hoping for a reply and godbless.

  93. Nors on July 2nd, 2013 6:46 pm

    Hi mona, yes, tama yong info na sinabi ng tinawagan mo. Payment of 9 of the 12 months BEFORE month of operation ang requirement. Sad to say na hindi binibilang yong advance payments. Aside from that, hindi na rin agad-agad ang cataract operation. You need to have pre-authorization, meaning punta muna kayo sa doctor, then yong doctor mag-rerequest sa Philhealth ng authorization to perform cataract surgery.

  94. Nors on July 2nd, 2013 10:57 pm

    Hi rokezza, baka yong tito mo, na-confine kaya covered yong CT scan niya. Ang alam ko, hindi covered ng Philhealt ang CT scan kapag ito ay gagawin na outpatient at kapag purely diagnostic lang at walang treatment na mangyayari. Malayo ka ba sa East Avenue or PGH or any other government hospital? Kung puede lang, tiyagain mo muna ang PGH outpatient (Padre Faura entrance; dapat pumila na ng about 530 or 6 am), kasi magagaling sila don. Kasi baka di ka qualified for Philhealth. Kapag voluntary Philhealth member, payment of 3 of the past 6 months ang required for non-surgery confinements; payment of 9 of the past 12 months for surgeries. You might like to read this: http://pghneuro.wordpress.com/faqs/ God bless. I’ll pray for you…

  95. rokezza on July 3rd, 2013 8:44 am

    yun na nga mam nors nandito ako sa negros..bacolod lang malapit na merong ct scan..meron po ditong govt. hospitals kaso walang mga apparatus..thanks po ng marami..it helped a lot.godbless. sana po marami pa po kaung taong matulungan..

  96. Jose on July 5th, 2013 3:50 pm

    Hello po inquire lng po sana ako regarding sa paggamit ng philhealt ng mother ko…siya po ay 55 yo voluntary member…ichechemo po siya by next week july 9, 2013..government hospital po ang kaso ung philhealth po nia ang nabayran lngpo nia ay 2nd qtr to 4 qtr lang po…hndi po ba magagamit ang philhealth nia? kc nung naooperahan sia last month cholesectomy, hndi po ngamit itong phlhelth nia ang sabi, dapat nkbyd ng 1st quartr….tapos ngaun wla nnmng silbi itong philhealth nia sa pagchechemo..bale next year padaw magagamit itong philhealth…patulong nmn po kung anung dapt kong gawin..

    mraming slmt po…kc po nagugulhan npo ako kung saan ako manghahagilap ng pampachemo ng mama ko…

  97. Nors on July 5th, 2013 10:44 pm

    Hi Jose, ang rule kasi kapag Voluntary is payment of 9 of the 12 months BEFORE month of treatment. Kung July ang treatment, 3 monthly payments lang ang ma-count (Apr to June), kaya di pa puedeng gamitin. Is the government hospital in Metro Mla? Punta ka sa PCSO office ng hospital before the chemo schedule para ma-guide ka nila how to ask help form PCSO.

  98. jocelyn reble on July 9th, 2013 4:08 pm

    Good day po.inquire lang po ako kung yung 31,000 pisos na cover sa phelhealth sa thyroidectomy paano yun binabawas sa hospital bill?kasi kaka opera ko lang last june 13,2013 ng thyroidectomy sa cebu,tapus sa billing ko sa hospital 46,395 pisos,tapus sa surgeon ko 26,000 pisos,tapus sa anesthesiologest ko 13,000 pisos,tapus sa specialista ko sa guiter ko 6,500 pisos.binayaran ko lahat yun kasi di ko nadala lahat ng recibo ko sa year 2012 sa phelhealth ko,ang nadala ko lang M.D.R at whole year reciept ko sa taong ito 2013,at ang sa year 2012 hindi ko lahat nadala,kaya hindi na cover or nabawasan ang billings ko.ang sabi nila dalhin ko lahat ng reciept ko sa year 2012 sa phelhealth ko kaya yun dinala ko para daw ma refund nila ako.ANG TANONG KO PO,TAMA PO BA ITO ANG BINAWAS NILA? OR E REFUND SA AKIN?

    MEDICARE MEDICINES………5,000.00
    MEDICARE OR…………….5,000.00
    MEDICARE OTHERS/LAB/XRAY…5,000.00
    MEDICARE ROOM…………..3,600.00

    NET AMOUNT: 18,600.00

    NOTE;SABI NG CASHIER YAN LANG DAW ANG MAKUHA KO,OR MA REFUND SA AKIN.

    NAGTATAKA RIN AKO DITO BAKIT MAY NAKASULAT NA GANITO?

    ….MEDICAL FEES….

    DOCTOR CHARGES
    DR. R……..,E….. 7,440.00
    DR. T……. ,J….. 1,860.00
    DR. V……..,G……3,100.00

    TOTAL : 12,400.00

    BAKIT MY GANITO PO MAM?EH WLAA NAMAN TO SA AKING BILL,OR HOSPITAL BILL?ANONG IBIG SABIHIN PO NITO? ITO PO BA ANG MATATANGGAP SA MGA DOCTORS MALIBAN SA CASH NA BINAYAD KO?PARA ANG TOTAL LAHAT AY 31,000.00?HINDI KO TALGA MA GETS MAM..PASENSYA NA PO KAYO.KASI AKALA KO KUNG MAGKANO LAHAT NG BINAYAD KO SA HOSPITAL BILL AUTOMATIC NA IKALTAS YUNG 31,000.00 NA COVER SA PHELHEALTH.BAT GANUN NAG NANGYARI?MARAMING SALAMAT PO.GOD BLESS.

  99. Nors on July 9th, 2013 10:48 pm

    Hi jocelyn, you should get the full 31k from Philhealth (if you submitted also PF receipts plus doctors’ waivers) or from the hospital (if Philhealth issues the check to the hospital). 31k is allotted as 18,600 (60%) for hospital and 12,400 (40%) for PF. If the hospital does not return the 12,400, tell them that you’re going to look for the doctors and ask for refunds (surgeon 7,440, anesthesiologist 3,100, and goiter specialist 1,860)

  100. ruth on July 10th, 2013 12:49 pm

    Good day!
    I am one of the member of phil health my father 63 yrs old was admitted in public hospital at ang findings sa kanya pneumonia so nasa slot siya ng pneumonia 1 and it cost 15k. Ang tanong ko, makukuha ba namin ang 15k completely? kasi sa public hospital lang naman siya na confine pero ang mga gamot niya we buy it from outside pharmacy. Sabi kasi if the patient will admitted in public hospital we don’t pay anything because the phil health will pay for that, but our bill hindi naman umabot ng 15k kaya may refund pa ba sa amin? Thank you

  101. Nors on July 11th, 2013 11:06 am

    Hi ruth, after receiving your benefit payment notice from Philhealth, and the notice says that Philhealth paid the hospital 10,500 for hospital cost and 4,500 for PF, and your bill was less than 10,500, go to the hospital, ask for refund for some or all of the medicines that you bought outside.

  102. shiela on July 14th, 2013 9:26 am

    gud am po, nanganak po ako last june 26 and binayaran namin lahat ng bils 13k po un to be exact..for reimbursement nlng ung philhealht ko, ang problema po may hinihingi ang lying in na OR ng philhealth fron august 2012 – april 2013,ang problema po ay hindi na makita ng employer ko ung jan at feb 2013 na OR nila ng bayad sa philhealth,,ayaw po tanggapin ng lying in ung requirements ko kasi daw po kulang,, pero may certification ako galing sa employer ko na may hulog sila until april this yer,, gsto ng lying in may katibayan na OR kasi daw pwd pekein un..diba nakikita naman sa phealth ang lahat ng hulog namin?pag ako po ba maglalakad ng reimbrsement namin diko na kelangan ng OR na un?sabi po ng lying in 4500 lng daw ang mapapa reimburse namin,, totoo po ba un? magkano po ba dapat?tnx

  103. devyjean moreno on July 14th, 2013 10:18 am

    Good day! I just want to ask po if may mababawas po sa endoscopy procedure n gagawin po sa akin ng hospital? Member po ako ng philhealth…. thank you po! Mga how much po kaya iyon? Khit po ba outpatient daw po ako pwede un? Thank you!

  104. Nors on July 14th, 2013 8:28 pm

    Hi devyjean, sorry but it might not be covered if the procedure is for purely diagnostic purpose. Kelangan kasi sa claim ang code of illness and treatment. To be sure, ask the doctor or the hospital if you can use your Philhealth for the procedure.

  105. alvin on July 16th, 2013 11:37 pm

    Hi,i would like to inquire how much will be the amount to be reimbursed by philhealth for the IJ (internal Jugular)surgery for dialysis?because my dad have just undergone that surgery in NKTI today,and we paid a total amount of 14,500.00 (6.5k for the hospital and 8k for the doctor). I already have the form 1 and 2 signed by the doctor and i have all the receipts we paid. But I went to philhealth office,and the staff told me that I have to get a waiver from billing dept. and doctor which indicates that there were no philhealth deductions made..why do i have to secure a waiver,when i already have the OR from the hospital & doctor?is there a certain amount that philhealth would refund? because the staff from philhealth told me that it would be subject for evaluation.thank you

  106. Santy on July 17th, 2013 3:53 pm

    Good afternoon po,

    My mom (85 years old) is my Philhealth dependent and currently hospitalized due to kidney problem. The hospital asked us to buy some meds outside as the items are not available from their pharmacy. May I kindly know then if we can reimburse some, or if not all, of the cost (is it either from hospital or Philhealth)?

    Moreover, the attending physician’s resolve is for my mom to undergo hemodialysis procedure. May I know if such procedure is covered by Philhealth and how many sessions are covered?

    Also, I’m a lifetime Philhealth member. Do my dependents (spouse & mother) automatically become free lifetime members as well when I get retired?

    Thank you very much for your kind help!
    Santy

  107. Nors on July 17th, 2013 11:48 pm

    Hi alvin, IJ is not under the case rate scheme, so I cannot give you the exact coverage. Philhealth will use the old scheme, which is sometimes better than case rate. About waiver: it’s better if you submit the waiver so that the check will be issued in your dad’s name (if he’s the member); ORs usually don’t say if that’s all the costs incurred. I think that ORs together with a statement of account should be enough; but a waiver is a surer document that no Philhealth deduction was made. I understand your frustration — patients’ lives would be much better if hospitals and doctors issue waivers automatically if they don’t make outright Philhealth deductions.

  108. Nors on July 18th, 2013 12:32 am

    Hi Santy, you can refund all or part of the costs of those meds if the Philhealth allocation for meds (under fee-for-service scheme) has not been used up by the hospital. The benefit payment notice that you will receive from Philhealth via registered mail will show if you still have some money to refund from the hospital. Keep copies of your receipts.
    About hemodialysis: yes, it’s covered at Philhealth accredited dialysis centers/hospitals. Coverage is 4k per session (500 of 4k is for PF); 45 sessions per year (if no other dependent uses part of the 45-day allocation). Per Philhealth rules, 45 days are allocated to each member; another 45 days are shared by his dependents.
    About lifetime membership: yes, your mom and spouse will continue as your dependents, lifetime.

  109. ruth on July 20th, 2013 5:49 am

    Good day!
    Nor yong bill ng father ko is 3,500 sa public hospital.. ibig sabihin my refund pa? kasi nasa slot siya ng 15k. Lahat ng gamot we bought it from outside hospital pharmacy.

  110. Nors on July 20th, 2013 10:01 am

    Hi ruth, wait for the benefit payment notice from Philhealth, so you can see how much Philhealth paid the hospital. Xerox the notice and your receipts then ask for refund from the hospital for the cost of the meds.

  111. Janice Dorado on July 27th, 2013 2:34 pm

    Good Day, am a Public School Teacher and recently my OBGyne found a 10cm. Uterine Fibroid in my uterine wall and advised for an immediate surgery. Does Philhealth covers the whole surgery expenses or only a part of it. Thank you very much for your immediate response . .

  112. Nors on July 27th, 2013 7:32 pm

    Hi Janice, Philhealth covers only a part of your costs. That surgery is not under Case Rate, so I cannot give the coverage amount. You should first ask your surgeon the hospital cost and PF, and expected Philhealth deduction. Usually doctors work with several hospitals, so ask your ob-gyne or surgeon in which hospital they’re affiliated with you can have that surgery at a lower cost.

  113. Mario on August 1st, 2013 1:03 pm

    hello po. I was confined in June 2011 for about 6 days, then in July 2011 for 4 days, January 2012 for 4 days and July 2012 for 4 days.

    What I know is I am entitled for 45 days per year.

    Paano po ba ang computation? per confinement as long as you do not exceed 45 days or total amount of benefits received?

  114. flora on August 1st, 2013 3:59 pm

    hi inquire lang sana ko about sa naging bill nmen..naconfine baby ko last march nagka pneumonia sya bale 15000 ang benefit..we had an actual bill of 12800 then ung nacover lang is 12000 and we paid the remaining 800 to settle the bill..is there any possibility that we can still have a refund from the hospital since according to our bpn philhealth paid all the 15000 to the hospital?

  115. Nors on August 1st, 2013 8:21 pm

    Hi Mario, yes, every member is allotted 45 confinement days per year. But there’s a rule that the 2nd or 3rd or subsequent confinement for the same illness within 90 days is not covered. Coverage amount depends on the illness. Case rate will apply if the illness is in the Case Rate list. If not in the case rate list, coverage will be under the old system — limited amounts for meds, room, PF, OR and lab depending on illness severity and doctor/hospital category.

  116. Nors on August 1st, 2013 8:56 pm

    Hi flora, xerox your notice, your bill and receipt para may kopya kayo, then present the original copies to the hospital to refund your 800.

  117. Lorena O. Magtibay on August 3rd, 2013 10:25 am

    Hi,my daughter is now confined in the hospital having 3 illnesses namely pneumonia,dengue and typhoid.I was told that only one (1) diagnosis will be covered by Philhealth.
    The doctor said that Dengue (Moderate Risk) is the main condition.How much deductions would I get from Philhealth.Thanks.

  118. Nors on August 3rd, 2013 10:32 am

    Hi Lorena, yes, it’s the main condition that will be covered. Coverage for moderate-risk dengue is 8k (5600 for hospital, 2400 for PF). Hope your daughter is already getting well.

  119. Lorena O. Magtibay on August 3rd, 2013 10:48 am

    Thanks.

  120. Bella Gonzaga on August 4th, 2013 10:45 am

    Hello po, i have question about my daughter’s hospitalization if i can still use my philhealth to her even if it was recently used 15 days ago but in a diferent illness.?

  121. Nors on August 4th, 2013 5:46 pm

    Hi Bella, yes, you can use it again because the illness is different, and your 45-day allotment per year for dependents is not yet consumed.

  122. marilet on August 11th, 2013 12:29 pm

    hi, I’m marilet. asked ko lang po if I am covered with philhealth. It’s my 5th pregnancy. The 3 previous are all NSD my fourth is CS section and now my 5th will be CS again? another question I just updated my philhealth first quarter of 2013 and paid already the whole year 2013 am I covered if my due will be on Oct. 6, 2013?

  123. Fatima Montebon on August 13th, 2013 1:12 pm

    HI this is Fatima, I am also a member of Philhealth. How many times can I used my philhealth in a year? is there a limit?
    Thanks!

  124. Nors on August 14th, 2013 12:52 am

    Hi Fatima, Philhealth will cover only 45 days of confinement per year per member. There’s an additional allocation of 45 days that will be shared by the member’s dependents. Also, if 2 or 3 or more confinements within 90 days are because of the same illness, only the first confinement will be covered.

  125. ruel on August 15th, 2013 1:38 pm

    gud morning maam… I would just like to ask how much the philhealth coverage for “Acute Gastritis” is?…. thank u very much… God bless

  126. Nors on August 16th, 2013 8:04 pm

    Hi ruel, I’m not a doctor, so I googled if acute gastritis and acute gastroenteritis, which is under Case Rate, are the same. They’re not the same. So acute gastritis will be paid under the old coverage scheme. Merong benefits for meds, room, PF, lab, OR with maximum limits depending on the actual costs, illness and hospital/doctor category.

  127. angel on August 25th, 2013 1:49 am

    Gud am mam i was given birth last march binayaran po namin buo ung pf and hosp bill ko total would be 14k na. After 3 days pumunta kmi sa philhealth office dito samin para iclaim ung nsd package tas ung nakausap namin na agent doon ang sabi hindi daw pwede iclaim kc hindi daw kmi kasal tas hindi daw pwede pag magkasama kmi sa iisang bubong.. is it true ba na bawal makaclaim ng benefit dahil lang sa nagsasama kau sa iisang bubong na hindi pa kasal? Policy ba un ng philhealth?

  128. Nors on August 25th, 2013 11:34 am

    Hi angel, sino ba ang Philhealth member? ikaw o ang partner mo? Kung hindi ikaw ang member at hindi kayo married ng partner mo na siyang member, sori hindi ka niya puedeng dependent. Puede lang dependent yong merong maipakitang marriage certificate. Yong anak nio, in case of future needs, yon ang puedeng dependent ng partner mo kasi anak niya rin at merong birth certificate showing that he is the father.
    Pero kung ikaw ang member, makaka-claim ka kahit unmarried o married.

  129. angel on August 26th, 2013 2:46 pm

    Ako po ang member nors… bakit ganon ang cnabi samin? Tanga lang ba tlaga ung agent na un or xa ang hindi alam ang mga patakaran ng philhealth? I cannot claim na ba un kht over a year na nakalipas? Npka sayang..

  130. jianna on August 26th, 2013 2:53 pm

    Hello po ask ko lng po sana kc ung 3mos. Baby ko ngka broncho pneumonia xa we stay at the hosp for 2 days ang bill nmin is almost 5k lahat2 na un andon na. Bnayaran nmin xa cash. Then irereimburse nlng sa philhealth. Ako po ang member. Ask ko lng kc sa case rate ng pneumonia 1 is 15k tas ngastos lng nmin sa hosp is 5k.. mkukuha ba nmin ung buong 15k ng philhealth or ibabase nila sa mga nagastos lng nmin?

  131. bhing on September 1st, 2013 9:07 pm

    Gud eve po tanong ko lng po mga magkano po yung inguinal hernia surgery?at magkano rin po ung covered ng phil health?thanx

  132. Nors on September 1st, 2013 11:48 pm

    Hi bhing, ang coverage ng herniorrhapy is 21k (12600 for hospital at 8400 for doctor)

  133. Che on September 3rd, 2013 10:11 am

    good day, ask lang po. i have already my BPN from philhealth, they said ipakita ko raw ito sa hospital for refund. i called hospital kung saan ako nanganak, sabi nila they need photocopy of BPn and OR receipts. what OR they mean? eh, yung OR sa mga nagastus ko naipasa kona sa philheath which is required yung nagfile ako. thanks

  134. jem on September 5th, 2013 1:17 pm

    Hello po. Magtatanong lang po regarding po sa benefits ng philhealth for patients undergoing chemo. Magkanu po ba ang ikakaltas sa hospital bill availing the philhealth benefit. Sa ust po ang chemo nya. Per session po ba yung kaltad or lump sum? Appreciate your kind reply. Fyi govt employee po mom ko baka lang may edge. Thanks po.

  135. Nors on September 5th, 2013 9:57 pm

    Hi Che, tell the hospital that you submitted the ORs to Philhealth. The hospital can trace if your Philhealth was deducted, or if you paid them in full, without deduction.

  136. Nors on September 5th, 2013 10:30 pm

    Hi jem, sa Philhealth, all members get the same sets of benefits, regardless of whether they’re in government or in the private sector. Chemotherapy is covered under the fee-for-service scheme, so the amount is not fixed. If this is breast cancer or cervical cancer, ask Philhealth about the Expanded Case Type Z scheme kung qualified kayo.

  137. jem on September 7th, 2013 10:22 am

    Thank you po. Hodgkins lymphoma po ang case ng mom ko. We’ll inquire na lang po after ng chemo nya. She will be scheduled next week. I am hoping somehow makatulong yung philhealth nya to ease the burden of paying big amount of money for her medication. Thank you po once again for the advice.

  138. lorraine ann rael on September 7th, 2013 3:53 pm

    while I was undergoing C-Section the doctor also found out I had a case of appendicitis. so we decided to also do an appendectomy procedure. Philhealth only covered the C-section amounting 11k which is supposedly 19k. The philhealth in the hospital said 8k has been deducted from doctors fee. is that possible?
    and also they didn’t cover the appendectomy which cost 24k because they said C-section is the main operation done. Can Philhealth cover both surgical procedures? why or why not? Thanks.

  139. Nors on September 8th, 2013 8:14 pm

    Hi lorraine, the CS coverage of 19k is allocated as 11400 for hospital and 7600 for PF. If your doctor deducted 7600 from her PF, then that’s great. Based on comments on our blogs, many doctors do not deduct or refund the 7600; they take it as additional fee.
    About CS with appendectomy, Philhealth’s rule is that all these cases have the same 19k coverage: CS only, CS with BTL, CS with incidental appendectomy, and CS with adhesiolysis.

  140. lorraine ann rael on September 9th, 2013 9:09 am

    so you mean CS + Appendectomy is 19k only. or 19k + 19k should be deducted?

  141. Nors on September 9th, 2013 10:09 am

    Hi lorraine, sad to say, yes, CS + Appendectomy is 19k only. Purely CS, 19k ang coverage. Ganon din pag kasama ang appendectomy, 19k pa rin, walang dagdag.

  142. lorena on September 11th, 2013 10:46 pm

    Hi….good evening po. Tanong ko lang maari ko bang gamitin ulet yong philhealth. Kahit nagamit ko na ito. Mga ilang day pweding magamit kung parehong case lng. At gaano ba katagal yung refund ng philhealth acording sa mga gamot na nabili sa labas ng hospital. Salamat sana masagot ang mg tanong ko. God blessed

  143. Nors on September 12th, 2013 7:58 am

    Hi lorena, kapag parehong illness sa loob ng 90 days, hindi maco-cover ang 2nd or next confinements, except for dialysis. About refund: 3 to 5 months or longer pa rin ang refund. Wait for the benefit payment notice from Philhealth, and then get your refund from the hospital. Keep your ORs.

  144. Jordan D Casipe on September 14th, 2013 9:09 am

    Hi, i want to know if we can use my mom’s Philhealth, she has been inactive for quite a long time, then we paid contribution for july-sep, i am a beneficiary, can we use it now? Coz i think im getting sick.

  145. Nors on September 14th, 2013 10:58 am

    Hi Jordan, are you 21 or younger? Unmarried and unemployed? If yes to all, puede kang dependent. Pero hindi mo pa puedeng gamitin, kasi dapat 3 of the 6 months BEFORE confinement ay nabayaran ng premium kapag ordinary illnesses. Pag surgery or maternity, dapat paid ang 9 of the past 12 months.

  146. Ma. Jocelyn Sumague on September 15th, 2013 10:07 pm

    Hi! I was confined last Sep 9-11, 2013 due to UTI and after a series of tests it was found out that I had kidney stones and advised to undergo ESWL. Since the procedure was not available in the hospital, we were referred to another hospital. The procedure was scheduled on Sep 18. Could I still avail of my philhealth benefit for the procedure and how much? As in patient, out of the 40K hospital bill, only 4K was covered by philheath. Hope to hear from you very soon. Thank you and God bless!

  147. Nors on September 16th, 2013 8:14 am

    Hi Ma. Jocelyn, ESWL is not under the Case Rate scheme, so I cannot say the fixed coverage for this procedure. Ask your surgeon for the cost if you use your Philhealth.
    If you are asking about the 90-day single period of confinement, I think you will be covered since UTI is different from ESWL. God bless din.

  148. Marlo on September 20th, 2013 3:58 pm

    Good day! Just would like to ask if it is fair that Medical Center Paranaque computed the Philhealth benefit of my father in law at only P6,000.00. He was hospitalized for more than 2 weeks and the hospital bill reached almost 100 thousand pesos, excluding some medicines that we immediately bought upon prescription. He was diagnosed with a lot of illnesses and underwent dialysis for 4 times during his stay in the hospital. Thank you

  149. Nors on September 20th, 2013 9:09 pm

    Hi Marlo, indeed, it’s not fair. Pero kapag multi-illnesses at the same time, usually isa lang ang kino-cover, at depende kung anong illness ang isusulat ng doctor sa claim forms. Anong illness ba? Nasa case rate list ba? Ask the billing department about your correct Philhealth deduction.

  150. Marife M.Mahumot on September 24th, 2013 10:32 pm

    Hi! ako po si marife.dedendent po ako ng asawa ko sa philhealth. Nanganak po ako last august 26,gusto ko sanang magpa-ligate.puwede ko ba ulit magamit ang philhealth para magpa-ligate kahit nagamit ko na ito sa panganganak ko?

  151. Nors on September 25th, 2013 3:22 pm

    Hi Marife, nagagamit uli ang Philhealth within 90 days basta different illness or condition. So, I think so, kasi iba ang maternity sa tubal ligation. Pero para sure, ask mo yong ob-gyne mo.

  152. lanie on September 29th, 2013 4:33 pm

    Hi po. Ako po c lanie na admit po ako last aug 22, 2013 hnd ko po nagamit philheath ko that time kasi ng iadmit ako tsk plng ako ngapply ng philhealthko po kya inaply ko s philhealth pr mk reimburse s binayad kons hospita mghnty dw po ako ng 2 months kungg ma aaprubahanl ask ko lng po kng pwede ko gamitin ang philhealth ko ngaun kc pp opera po ako. Salamat po

  153. Nors on September 29th, 2013 7:14 pm

    Hi lanie, do you mean last August ka lang nag-start mag-member at nagbayad? Hindi ka naman OFW? Kung last August ka lang nag-start at hindi ka OFW, hindi ka pa eligible. Kung individual payor, hindi nagagamit agad ang Philhealth. Kung OFW, puede agad-agad.
    Kung surgery, dapat nabayaran ang contributions for 9 of the past 12 months. Kung non-surgery, dapat nabayaran ang 3 of the past 6 months.

  154. janice on September 30th, 2013 3:51 pm

    Hello gud day..
    ..my father is suffering nasal polyps and his doctor advice him to undrgo polyps removal! the doc said, he needs first to b CT Scanned..can we use philhealth for his CT SCAN even without confinement? my father is already a senior citizen!thank u…

  155. Nors on September 30th, 2013 9:28 pm

    Hi janice, sorry but CT scan is a diagnostic procedure, and this is not covered if it’s not done during confinement. But ask the hospital or Philhealth; there might be changes in policies.

  156. joanna on October 1st, 2013 7:59 pm

    Good day! I will be giving birth this coming November and I will be going to a private hospital here in Baguio. We have already planned for ligation as well right after my delivery(normal delivery). I would like to ask how much will Phil health covers. Thanks in advance..

  157. Nors on October 2nd, 2013 12:39 am

    Hi joanna, the coverage for normal delivery is 5k (3k for hospital and 2k for PF). Coverage for ligation is 4k. Ask your ob-gyne too. Submit prenatal ORs so you can avail of prenatal refund. Submit 2 sheets of signed claim form 1, for maternity and for newborn care

  158. Edilberto Obierna on October 15th, 2013 8:10 am

    Good Day,ask ko po kung mag kano po ang Philhealth benefit claims pag NSD-BTL package.Pang 5th birth na po ang normal pero sa 3rd birth palang po nag start ng Philhealth claims..ossible po kya na 10500 ang makukuha.???One more thing po..kame po ng bayad lahad ng Hospital bill w/ PF ..reimburse ko po sana un para sa philhealth claims kaso po ang binibigay lan samin eh 3k …My wife gave birth last Oct 10, 2013..Our package is 55k NSD-BTL..nung mag discharge na kme bglang nag 66k po eh sabi po ng OB FIX po un 55k kase PO 50K FOR Private +5k for BTL…San Po KyA pede magrelamo regarding dun…normal po lahat ng ginawa..sa EACMC salitran Dasma po ..tnx

  159. Nors on October 15th, 2013 6:21 pm

    Hi Edilberto, ang alam ko, hindi na kayo eligible for NSD kasi 5th child na, kahit hindi nio nagamit noon ang Philhealth. Yong BTL, eligible kayo, 4k coverage. Sad to say, ang mga private hospitals at doctors puede silang mag-dictate ng presyo nila. Ang alam ko wala pa tayong law na naglilimit ng mga hospital and PF rates. Dictated by market ang nangyayari. Kaya nga dapat merong pag-uusap between pregnant woman and ob-gyne before delivery about costs. Kung 55k ang usapan, sana ipinilit nio ang 55k, pero siempre hindi ko alam kung anong pressure kayo under during that time. Hingin nio na lang yong mga accomplished claim forms plus waiver from the hospital and doctor para maka-file kayo within 60 days for the BTL coverage. Ask others too.

  160. Rizza Balisalisa on October 18th, 2013 6:38 pm

    Hi Ms. Nors, ask ko lang po ung father ko po kc will undergo chest ct scan contrast guided by biopsy for pulmonary mass sa LUNG Center sa tuesday. Just want to inquire kc po wala na syang work since February till now so natigil po ung pagbabayad nya ng contribution panu po kaya magging active un? Gusto ko po kcng bayaran ung time na hndi sya nakapaghulog. Tska macover po kaya ng Philhealth ung surgery na gagawin sa knya?

  161. Nors on October 19th, 2013 1:06 pm

    Hi Rizza, ang payment deadline for a quarter is the last day of the quarter. Outpatient ba gagawin ang ct scan ng father mo? If outpatient, hindi ito macover ng Philhealth kasi diagnostic ang ct scan, walang treatment. Ma-cover lang ang small portion ng ct scan kapag confined at merong treatment. You can pay for your father’s Philhealth for this quarter and continue paying later on for future needs. He can only enjoy his free lifetime membership starting at age 60 and if he has accumulated 120 premium payments. Ask others too

  162. ROGELIA S. YBARRA on October 21st, 2013 12:03 pm

    Goodmorning, paano ko ma claim yong PHILHEALTH Benefit ko or reply sa PHILHEALTH ko. Tinanggal and left kidney ng asawa ko noong Aoctober 29, 2012 at Lumabas kami ng hospital noong November 1, 2012 at natapos namin ang filing noong november 4, 2012. hanggang ngayun wala pang reply. Ang pangalan ng asawa ko MARIO BERNALES YBARRA ang member ay si ROGELIA YBARRA.

  163. Nors on October 21st, 2013 9:50 pm

    Hi Rogelia, visit the nearest Philhealth branch and ask about your claim. Tell them it’s already almost 1 year since you filed your claim. Sorry this blog is not administered by Philhealth; it’s a personal blog.

  164. Maria Fe Pesante on October 23rd, 2013 10:29 am

    gud am. .can i ask if endoscopy must be cover for philhealth insurance

  165. Nors on October 23rd, 2013 9:59 pm

    Hi Maria, endoscopy is a diagnostic procedure, so if it’s done as outpatient, it’s not covered.

  166. diane on October 24th, 2013 9:37 pm

    hello! my nephew is just 8 mos and we want him to undergo herniorrhaphy at public hosp here in quezon province. is that covered by philhealth? and by the way its just our 2nd quarter of contribution in philhealth can we still use that on his surgery? and how much is the estimated cost? tnx

  167. Nors on October 24th, 2013 11:16 pm

    Hi diane, the Philhealth coverage for herniorrhappy is 21k (12600 for hospital and 8400 for doctor). Ask the hospital/doctor how much you will pay if you use Philhealth and if you’re going to buy meds and supplies outside the hospital. Many govt hospitals do not have enough meds and supplies in their pharmacies. Xerox your receipts and have patient’s complete name on the receipts.

  168. diane on October 25th, 2013 7:05 am

    good day. i just wanna ask what is the required weight of 10 mos baby who will undergo hernia operation? tnx

  169. Jen on November 9th, 2013 10:38 am

    Hi, my sister got admitted and is about to have appendectomy.
    How do i apply philhealth claims along with her health card.

  170. Nora on November 10th, 2013 7:46 am

    Hi Jen, before discharge, submit your sister’s MDR, premium payment receipt (orig and xerox) and claim form 1.

  171. razhielle on November 15th, 2013 7:41 am

    Hi po. Ask ko lang po if same ang coverage ng philhealth ng masa at un regular philbealth. CS po ako at manganganak po this coming december.ska anu anu po ba yun pwede ko ireimburse after manganak.salamat po

  172. razhielle on November 15th, 2013 12:02 pm

    Ask ko lang po how much ang cover ng philhealth ng masa sa CS operation. Salamat po

  173. razhielle on November 15th, 2013 12:05 pm

    Hi I just want to ask how much is the coverage of Philhealth ng masa in Cs operation. Thanks

  174. Nora on November 15th, 2013 2:55 pm

    Hi razhielle, yes, pareho ang benefits ng sponsored card at regular card. Kapag CS, kelangang kausapin mo ang OB mo kung magkano pa ang babayaran mo kung gagamit ka ng Philhealth, kasi minsan, hindi binabawas ang Philhealth benefit sa PF ng OB. Meron pang mga cases in some government hospitals na cheaper kapag charity case kesa paying-case na gagamit ng Philhealth, although usually mas okay ang treatment kapag paying patient. Ang CS benefit under Philhealth Case Rate ay 19k (11400 for hospital expenses at 7600 for PF).

  175. razhielle on November 15th, 2013 7:49 pm

    Thank you for.replying on my inquiry. I also want to ask if the medicines that will be used on the operation will be covered under the 11k hospital expenses? Or will it fall on a diff category?

  176. Nora on November 16th, 2013 1:31 pm

    Hi razhielle, kasama na ang medicines sa 11,400. Kung government hospital ito, at bibilhin sa labas ang meds, have the ORs written in your name, and keep copies.

  177. ula on November 19th, 2013 10:02 am

    gud am po..ask ko lng po kung gaano po ktagal antayin po ung benefits n makukuha po s philhealth?gling lng po kc kmi s public hospital.nai-file n nmn po lhat ung mga or ng medicines and laboratory result,.iba po dw kc kpg s private and public hospital.tnx

  178. ula on November 19th, 2013 10:04 am

    stroke nga po pla ang case and 59 yrs old..slamat

  179. Nora on November 19th, 2013 6:19 pm

    Hi ula, usually 4 to 8 months ang inaantay. I hope you have copies of your receipts. Ang mangyayari is the hospital will file with Philhealth and then you wait for your benefit payment notice via registed mail. Pag meron na, punta na sa hospital and ask for your refund.

  180. eula on November 20th, 2013 8:16 am

    gandang araw po.ask ko din po, kc case rate daw po ung nangyari s mother ko po n stroke.Meron p po b n ibang benefits po n makukuha bukod p po s reinburstment ng gamot & laboratories?slmat

  181. crizette on November 21st, 2013 9:03 am

    Good day mam/sir,ask ko lng po kung makapag avail po ako ng philhealth magpapa surgery po ako next year may philhealth po ang asawa ko at sponsor nya ako pero mag expired na ngayon taon ng december. Gusto ko po kumuha sa january ng individual member po ako ang tanong ko po pwede po ba ako magbayad ng para sa isang taon na ng 2014 sa philhealth? Kelan po ako pwede mag avail ng surgery? Thanks.

  182. Nora on November 22nd, 2013 6:12 am

    Hi eula, kung naubos na yong coverage for hospital costs na 16,800 (for CVA1) or 22,800 (for CVA2), then wala nang marefund pa. The rest of the benefit is for professional fee. Wait for your payment benefit notice and if there’s a discrepancy, you ask for your refund.

  183. Nora on November 22nd, 2013 7:03 am

    Hi crizette, sana ang husband mo na lang ang magpatuloy ng membership at dependent ka pa rin niya, para magamit mo agad any time next year. Keep your 2013 premium receipts. He can renew in advance this month or next month. Kung ikaw ang mag-member, puede mo lang gamitin for surgery after 9 months. Puede ang after 3 months kung ang category mo ay Informal Sector.

  184. Christy Undag on November 27th, 2013 1:26 pm

    helo po…ask lang po ako, ano po bang mga diagnosis ang hindi e cover ng philhealth? kasi po na admit ang mr….na ang dignose sa kanya ay intoxication of liquior and over fatigue….christy

  185. Nora on November 27th, 2013 3:04 pm

    Hi Christy, kung merong medical reason yong over-fatigue at merong treatment, puedeng macover, or merong serious allergy sa liquor at merong treatment. Tanungin nio lang po sa hospital o doctor kung puedeng icover.

  186. Arianne Loren B. Argete on November 28th, 2013 8:38 am

    My husband is an active paying OFW Philhealth member. Honestly speaking, Philhealth is such a big help since I gave birth to our son, then with his 2 confinement and 3 major surgeries due to intussuception and colostomy creation,revision and reversal. I haven’t tried availing the Out Patient Care benefits. My son is expeeiencing headaches after a stair fall. We were ordered for a Cranial CT Scan with Contrast to be done. Does this procedure/test can be covered by Philhealth? If yes,how much is the maximum cost the Philhealth will shoulder? Thanks in advance.

  187. Nora on November 29th, 2013 10:27 am

    Hi Arianne, if those tests are performed while he’s confined and if there’s definite diagnosis and treatment, then part of the costs will be covered. If the tests are done as outpatient, I think they will not be covered because these are purely diagnostic procedures, there’s no diagnosis and there’s no treatment. But ask others too.

  188. Catherine on December 3rd, 2013 5:26 pm

    Helow po, ask lang po ako kung cover ba nang Philhealth ang operation ng goiter?

  189. Rinah on December 5th, 2013 1:56 am

    Gud day po!i was operated last Nov.10,2013 with acute cholecystitis (cholesystectomy)at Mandaluyong city Medical hospital, We filed our documents to philhealth.They said they are going to handle my bills. I JUST WANT TO ASK SINCE my operation is covered by the philhealth. cAN I STILL HAVE CLAIM OF A REFUND OR THE EXCESS TO the amount I will RECEIVE. pls. don’t get offended can i ask how much will i claim for the surgical cholecystectomy and how long will i wait? thank you

  190. Nora on December 5th, 2013 9:49 am

    Hi Catherine, yes, basta accredited ang hospital at doctor. Talk to the doctor about how much you’re going to pay if you use Philhealth.

  191. Nora on December 5th, 2013 9:34 pm

    Hi Rinah, the coverage for cholecystectomy is 31k (18600 is for hospital and 12400 is for the doctor). If you spent less than these coverage amounts, your refund will only be up to what you actually paid. The excess will go to the hospital/doctor. No, thanks, you did not ask any question that offended me :)

  192. dani on December 6th, 2013 2:52 pm

    good day po. naoperahan po sa kidney ang misis open surgery dahil sa malaking bato.70thous po ang singil ng doctor kasama na anesthesiologist hindi kasama don ang mga gamot at room na 3000 per day. mga magkano ba ang cash out namin after philhealth?

  193. Nora on December 8th, 2013 9:45 pm

    Hi dani, hindi kasi under the Case Rate scheme ang kidney surgery, so hindi fixed ang rate. Magde-depend sa coverage limits under the fee-for-service scheme, https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1 so tanungin nio na lang ang billing dept.

  194. alfie on December 25th, 2013 6:53 am

    Merry Christmas po and gud day….ask ko lng po kadi nung deDecember 7-13 naconfine anak dahil sa dengue 1 ngayon po yung isang anak ko may dengue na rin pwd ko po ba uli magamit yung philhealth ko dengue 1 uli ang diagnosed nang doctor …tnx po

  195. Nora on December 25th, 2013 7:00 pm

    Hi alfie, ang alam ko puede pang ma-cover kasi ibang tao (ibang dependent) naman yong patient. At saka hindi pa naman naubos yong 45 days na allotted for all your dependents. Kapag the same patient and the same illness within 90 days, yong second confinement ay hindi covered.

  196. Mich on December 31st, 2013 8:17 am

    Good day. Ask ko lang po. Just this December my father was confined in the hospital for 8 days with chronic kidney disease and his lung have water. His bills was deducted with philhealth but we pay cash in dialysis as what the Doctors are required and without philhealth deduction. Is it possible that he can still claim from the said dialysis which we pay in full in every session?
    Thank you and more power

  197. Nora on January 1st, 2014 8:43 am

    Hi Mich, yes, your father has 45 days of coverage for every year to consume. One dialysis session is equal to one day. Coverage of 4k per session. Look for a Philhealth-accredited dialysis center and ask for their requirements, so you can just go there and have the dialysis according to schedule.

  198. Juvy P. Flores on January 6th, 2014 4:44 am

    Hello po, Hindi covered ang CTscan ng philhealth, tanong ko po e yong mga gamot pwede po bang e pa refund?thanks

  199. rhea on January 6th, 2014 10:25 am

    Hi po tanong ko lang po, base sa case rate table nyo ang maternity benifits nyo nasa 8000, for normal delivery pero baket po pag dating ng hospital bill nagbayad pa po kami ang naging bill lang po namin nasa 6k+ po bukod pa po yun gamot na binile nmin outside, 5000 po ang nadeduct ng hosppital baket po hindi nasunod yun nsa case rate table nyo

  200. rhea on January 6th, 2014 3:50 pm

    Hi po tanong ko lang po, base sa case rate table nyo ang maternity benifits nyo nasa 8000, for normal delivery pero baket po pag dating ng hospital bill nagbayad pa po kami ang naging bill lang po namin nasa 6k+ po bukod pa po yun gamot na binile nmin outside, 5000 po ang nadeduct ng hosppital baket po hindi nasunod yun nsa case rate table nyo, incase po ba may marerefund po ako?

  201. Henry on January 6th, 2014 4:10 pm

    Good Day po, ask ko lang po sana if ang vericocele kung cover po ba sya ng philhealth for operation at kung magkano po ba ang cover na amount if ever cover sya ng philhealth? almost 2 years na pa ako ang contribution ko.

  202. Nora on January 7th, 2014 6:52 am

    Hi Juvy, covered ang gamot at CTscan kung naka-confine sa hospital ang patient, pero kung outpatient, hindi po.

  203. Nora on January 7th, 2014 6:58 am

    Hi rhea, if delivery is in a hospital, the coverage is only 5k. If in a clinic, the coverage is 6500. There’s an additional coverage of 1500 (6500 + 1500 = 8k) if prenatal ORs are submitted together with the maternity claim.

  204. myra on January 7th, 2014 11:50 pm

    good evening po.ask ko lang po.ilang session na po ba pwedeng magamit sa dialysis patient po ngayon?last year po 45 sessions po kasi ang nakuha po namen..how about po this year?nadagdagan na po ba??salamat po.

  205. Nora on January 9th, 2014 11:53 am

    Hi Henry, varicocele excision ba? Ang coverage ay 12,900 or 14,960. Ask your surgeon before the operation so you can prepare.

  206. Nora on January 9th, 2014 12:25 pm

    Hi myra, ganon pa rin po na 45 sessions per year.

  207. rino bagui on January 9th, 2014 5:23 pm

    mam sir tanong ko lmg po baKIT sa PGH NAHIN TAPOS PO CLA NG DOWN TAPOS PO LAHAT DAW PO GAGAMITIN NG PASIENTE BABAYARAN MUNA KAC PO PA DIALISYS KO PO SANA ANG ASAWA KO ANG ALM KOPO KAC MUTUTULUNGAN KAMING MGA MEMBERS NG PHILHEALTH PERO PARANG LALO KAMI GINIGIPIT DKO PO ALAM KAC KUNG CONFINED ANG ASAWA ADMIT NILA KAILANGAN MAY DOWN DAW PO DOWN AT LAHAT NA GAGAMITIN SA KANYA AY BABAYARAN MUNA UN BA PA PO PATAKARAN NG GOV HOSPITAL SA KAGAYA NAMING NAG BABAYAD SA PHILHEALTH

  208. rino bagui on January 10th, 2014 9:36 pm

    lahat ba po ng gov hospital nahingi ng down payment para macomfined or any medecal procedure kailangan bayaran muna lahat ng gagamitin sa pasyente na member ng philhealth

  209. Nora on January 10th, 2014 10:18 pm

    Hi rino, poor at corrupt kasi ang bayan natin kaya ganyan. Kulang ang pondo ng mga government hospitals kaya kulang ang stock nilang gamot. Sa charity, libre ang mga doktors pero ikaw ang maghanda ng mga gamot at supplies na gagamitin, kasi wala silang stock at wala silang pambili. Keep ORs in patient’s name for refund later on. Xerox them.

  210. Nora on January 10th, 2014 11:12 pm

    Hi rino, karamihan po ng government hospital, ganon, kasi kulang sila sa pondo, at walang pambili ng enough medicines and supplies, dahil poor ang Philippines o dahil ninanakaw ng mga officials. Ang libre ay mga doctors and nurses, basta sa charity department. Pero merong mga govt hospitals na nagpapabili lang ng gamot at hindi nagpapa-down payment. Magsulat po kayo sa Facebook page ng Philhealth

  211. tony on January 13th, 2014 3:47 pm

    good day nora! My wife had heart attack and has hypertension, she was admitted in ICU for 5 days, Where does her illness fall? . Can we get a refund for the excess if there is such? Thanks.

  212. Nora on January 14th, 2014 11:06 am

    Hi Diane, puede nating iresearch yan sa Internet, pero mas maganda siempre na surgeon mo ang magsabi ng tama para safe.

  213. Nora on January 14th, 2014 11:17 am

    Hi Tony, yong main diagnosis ang ma-cover, possibly heart attack. Puede ring ma-cover both; merong new rules. https://sites.google.com/site/informationphilippines/philhealth/case-rate-guidelines-2013
    If there’s excess from the coverage, it goes to the hospital. Pero kung private hospital, at ICU, malamang magdagdag pa kayo, pero siempre, we hope that the coverage is enough.

  214. alma corpuz on January 14th, 2014 4:29 pm

    Ofw po ako at kakamember ko lang po last month sa owwa, makaka avail na po b ang asawa ko kasi naospital siya ng two days, at pano po ang proseso

  215. Mercy P. Elona on January 14th, 2014 4:41 pm

    Good afternoon. I just want to ask if my voucher for my chemotherapy refund from the month of September to December are ready for release. thank you.

  216. Nora on January 14th, 2014 11:48 pm

    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.

  217. Nora on January 14th, 2014 11:53 pm

    Hi Mercy, sorry this website is not owned by Philhealth. Sorry I don’t have access to Philhealth’s database.

  218. anna casino on January 17th, 2014 1:53 am

    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.

  219. Nora on January 17th, 2014 7:54 am

    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?

  220. lourdes on January 18th, 2014 11:59 am

    good mrning! i have undergone a shockwave procedure in july 2013, aside frm philhealth i also also use my healthcard provided by our company.now 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!

  221. Nora on January 18th, 2014 3:35 pm

    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.

  222. marj logente on January 21st, 2014 11:19 am

    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

  223. Nora on January 21st, 2014 5:59 pm

    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.

  224. anna casino on January 22nd, 2014 1:12 am

    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

  225. Nora on January 22nd, 2014 4:19 am

    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.

  226. james on January 23rd, 2014 3:18 pm

    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,

  227. Nora on January 23rd, 2014 4:19 pm

    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.

  228. aubrey on January 27th, 2014 2:54 pm

    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

  229. Mercy on January 28th, 2014 12:04 pm

    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.

  230. Mercy on January 28th, 2014 1:06 pm

    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!

  231. Nora on January 28th, 2014 2:34 pm

    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.

  232. Nora on January 28th, 2014 2:59 pm

    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.

  233. Mariell Puertas on January 29th, 2014 6:47 pm

    hi i would like to ask if the MRI is included in philhealth benefits?

  234. Nora on January 29th, 2014 11:33 pm

    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.

  235. Florita Garcia on February 3rd, 2014 9:52 am

    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.

    Florita

  236. Nora on February 4th, 2014 8:49 am

    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.

  237. Bing on February 8th, 2014 4:25 pm

    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.

  238. Bing on February 8th, 2014 4:44 pm

    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.

  239. aireen on February 9th, 2014 2:37 pm

    hi poh,
    ask ko lang po,kung ilang month magagamit yong philhealth, pag magpapa member ka sa philhealth?

    Thanks

  240. Nora on February 9th, 2014 7:18 pm

    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.

  241. Nora on February 9th, 2014 7:32 pm

    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

  242. Nora on February 9th, 2014 7:47 pm

    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

  243. tontoon on February 10th, 2014 9:37 am

    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

  244. Gil Rawat on February 10th, 2014 10:51 am

    Good Morning,

    Meron po akong bukol sa likod. Gusto ko po ipaopera para matanggal. Magkano po ang covered ng Philhealth dun.

    Thank you.

  245. Gina on February 10th, 2014 11:47 am

    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?

  246. Nora on February 10th, 2014 12:10 pm

    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 youtube.com baka puede pang maremedyuhan na hindi muna surgery.

  247. Nora on February 10th, 2014 12:15 pm

    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.

  248. ERIC URBANOZO on February 12th, 2014 6:45 pm

    same pa din po ba ng kaltas sa all case rate kapag ang ospital ay LEVEL 1 CATEGORY lamang. salamat po….

  249. Nora on February 13th, 2014 5:32 am

    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.

  250. Mel Antonio on February 13th, 2014 3:40 pm

    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

  251. ron on February 13th, 2014 3:40 pm

    ano po case rate ng nephritis?

  252. Ronald on February 13th, 2014 5:05 pm

    may i know how much will be covered by PHIC for nephritis?

  253. Nora on February 13th, 2014 10:10 pm

    Hi ron, merong acute nephritic syndrome sa Case Rate list at ang coverage ay 10k (3k for PF and 7k for hospital cost)

  254. Nora on February 13th, 2014 10:15 pm

    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)

  255. eduardo diego jr on February 19th, 2014 1:56 pm

    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.

  256. Nora on February 21st, 2014 7:40 pm

    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

  257. Ana Pangilinan on February 26th, 2014 10:48 pm

    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.

  258. cha on February 27th, 2014 7:22 am

    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.

  259. piboy on February 27th, 2014 2:48 pm

    Naconfine ang anak ko at nadiagnose na rheumatic fever, meron bang medical case/case rate ito sa philhealth?

  260. Adelina R, castro on February 27th, 2014 3:51 pm

    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.

  261. Nora on February 27th, 2014 7:43 pm

    Hi Ana, usually ganon nga na dapat confined for at least 24 hours para ma-cover. Pero magtanong ka pa rin sa billing department.

  262. Nora on February 28th, 2014 12:55 am

    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.

  263. Nora on February 28th, 2014 12:58 am

    Hi piboy, yes, covered. Ang coverage ay 10,100

  264. Julie on March 2nd, 2014 6:10 pm

    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!

  265. Nora on March 2nd, 2014 9:08 pm

    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.

  266. Danmar s. bonghanoy on March 12th, 2014 3:28 pm

    when can i get my refund, Minglanilla District Hospital already posted my name last March 6, 2014

  267. Nora on March 12th, 2014 4:38 pm

    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).

  268. Luzviminda Cabigao on March 14th, 2014 3:10 pm

    Hi Im Lhuz. Ask ko lang po magkano ang covered ng philhealth for imrt at the lung center of the philippines.

  269. Nora on March 14th, 2014 5:07 pm

    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)

  270. lynn on March 18th, 2014 4:43 pm

    Mam ask ko lang po magkano opera ng myoma sa private hospital at public like PGH meron po kaming philhealth.thank you po.

  271. Nora on March 20th, 2014 2:43 am

    Hi lynn, ang coverage ng Philhealth ay: http://www.healthphilippines.net/2014/03/philhealth-coverage-myoma-myomectomy/
    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.

  272. Grace on March 22nd, 2014 7:02 pm

    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.

  273. Grace on March 22nd, 2014 7:05 pm

    ung sister ko po mismo na may hodgkins lymphoma ang member ng philhealth.thank you po ulit.

  274. Nora on March 23rd, 2014 1:13 am

    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.http://www.healthphilippines.net/2014/03/philhealth-coverage-for-chemotherapy/
    http://www.healthphilippines.net/2014/03/philhealth-coverage-for-non-hodgkins-lymphoma/
    For the next chemos, ganon uli na 5,600 per session.

  275. ma. rachel bismonte on March 25th, 2014 3:15 pm

    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

  276. Nora on March 25th, 2014 10:43 pm

    Hi ma. rachel, yes, if she paid for 1 year this March, and she is an Individual Payor-Informal Sector, then she can avail

  277. Gaylord Taloza on March 27th, 2014 8:15 pm

    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..
    Thanks…

  278. Nora on March 28th, 2014 11:53 am

    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

  279. Christine on March 30th, 2014 2:56 pm

    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.

  280. Nora on March 31st, 2014 8:53 am

    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.

  281. Sheryl MAe Villasor on April 2nd, 2014 10:06 am

    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?

  282. Nora on April 3rd, 2014 1:14 pm

    Hi Sheryl Mae, sad to say hindi na covered kapag the same diagnosis within 90 days. Ask the hospital too.

  283. Ella on April 5th, 2014 3:39 am

    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..

  284. Nora on April 5th, 2014 6:15 pm

    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.

  285. Riri on April 6th, 2014 1:53 am

    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.

  286. Nora on April 6th, 2014 3:11 pm

    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.

  287. Angelie Lucero on April 7th, 2014 6:17 pm

    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.

  288. Nora on April 8th, 2014 3:25 am

    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.

  289. Alvin Dizon on April 9th, 2014 5:28 am

    Hi boss, ask ko lang magkano ang covered ng phil health for biopsy for dependents?

  290. Nora on April 9th, 2014 8:56 am

    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)

  291. judith macaraig on April 10th, 2014 4:39 pm

    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.

  292. Nora on April 10th, 2014 8:18 pm

    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.

  293. al tan on April 10th, 2014 9:04 pm

    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.

  294. Nora on April 10th, 2014 9:30 pm

    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. http://www.philhealth.gov.ph/circulars/2013/annexes/circ35_2013/Annex2_ListOfProcedureCaseRates.pdf
    These are long lists, so press Ctrl F, so you can type pacemaker to search coverages for various pacemaker procedures.
    http://www.philhealth.gov.ph/circulars/2013/annexes/circ35_2013/Annex1_ListOfMedicalCaseRates.pdf
    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: maxicare.com.ph / medicardphils.com / intellicare.com.ph Check their rules on pre-existing conditions.

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