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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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