by Florencio Luyao
DIPOLOG CITY, NOV. 18(PIA)--- PhilHealth has adopted a new method of paying the medical care benefits of its members through the partners in health care delivery effective September 1, 2011.
This is contained in PhilHealth Circular numbers 11, 11-A & 11-B (Fixed Rate Cases & No Balance Billing Policy).
The Fixed Rate Cases method to pay for selected medical cases and surgical procedures aims to provide optimal financial risk protection especially to the most vulnerable groups, including the poorest of the poor. The Corporation would also want to empower the members more by letting them know exactly how much they can now avail themselves of for certain medical conditions and surgical procedures. Thus, for the partner-providers, the Fixed Rate Cases method equates to faster processing of claims and therefore faster reimbursement for the services they have provided to the members.
Earlier, PhilHealth has used the Fixed Rate Cases for such conditions as the outpatient malaria treatment, HIV/AIDS, tuberculosis treatment, cataract surgery and a lot more. However, this time, PhilHealth has expanded the list to include the most common medical conditions that they pay for, meaning, these comprise about 49 percent of all claims that they received, processed and paid for over the last year.
The following are the Fixed Rate Cases:
MEDICAL CASES (11)
| Dengue I | P8,000.00 |
| Dengue II | P16,000.00 |
| Pneumonia I | P15,000.00 |
| Pneumonia II | P32,000.00 |
| Essential hypertension | P9,000.00 |
| Cerebral infarction | P28,000.00 |
| Cerebro-vascular accident with hemorrhage | P38,000.00 |
| Acute gastroenteritis | P6,000.00 |
| Asthma | P9,000.00 |
| Typhoid fever | P14,000.00 |
| Newborn care package in hospitals and lying-in clinics | P1,750.00 |
SURGICAL PROCEDURES (12)
| Radiotherapy | P3,000.00 |
| Hemodialysis | P4,000.00 |
| Maternity Care Package Normal Spontaneous Delivery Package in Level 1 hospitals Normal Spontaneous Delivery Package in Levels 2 to 4 hospitals | P8,000.00 P8,000.00 P6,500.00 |
| Caesarean Section | P19,000.00 |
| Appendectomy | P24,000.00 |
| Cholecystectomy | P31,000.00 |
| Dilatation and curettage | P11,000.00 |
| Thyroidectomy | P31,000.00 |
| Herniorrhaphy | P21,000.00 |
| Mastectomy | P22,000.00 |
| Hysterectomy | P30,000.00 |
| Cataract surgery | P16,000.00 |
These new rates are applicable for all types of members, including those who are employed in the private and government sectors, the lifetime members, the overseas workers, the individually paying members and the sponsored program members. They may avail themselves of these Fixed Rate Cases in PhilHealth-accredited health care facilities nationwide.
However, the Sponsored Program members, are entitled to the ‘No Balance Billing’ policy when they avail themselves of any of these fixed case rates in the accredited government hospitals.
No Balance Billing means that no other fees or expenses shall be charged or paid for by the patient-member above and beyond the packaged rates.
This policy also applies when the Sponsored Program members avail themselves of outpatient surgeries, hemodialysis and radiotherapy in accredited non-hospital facilities that includes Free-Standing Dialysis Centers (FSDCs) and Ambulatory Surgical Clinics (ASCs). It also applies when they are availing themselves of the existing outpatient packages for TB-DOTS, Malaria and HIV/AIDS.
At the same time, all other member-types (employed in the private and government sectors, the lifetime members, the overseas workers, the individually paying members) are entitled to the No Balance Billing policy when availing themselves of the Maternity Care Package (MCP) and the Newborn Care Package (NCP) in accredited non-hospital providers (Rural Health Units, Birthing Homes).
For more information regarding Philhealth programs and benefits, its local office in Dipolog City has urged the public to listen to its radio program dubbed “Philhealth sa Radyo” aired over DXFL-FM every Tuesday from 12:00NN -12:30PM, where its various programs are discussed.
These are Philhealth registration, benefits, availment procedures, including the fixed rate cases and No Balance Billing Policy. The program also entertain questions and/or inquiries from listeners thru text. (JPA/ATR/FL /Philhealth/PIA9Zambo Norte)
