PhilHealth adopts ‘case-rate’ method
STARTING September 1, the Philippine Health Insurance Corporation (PhilHealth) has adopted the “case rate method” to pay for selected medical and surgical cases.
Under this system, PhilHealth members are informed on how much they can avail for specific cases.
Some of the medical conditions that will be covered using the case rate method are as: Dengue I, P 8,000; Dengue II, P16,000; Pneumonia I, P15,000; Pneumonia II, P32,000; Acute gastroenteritis, P 6,000; Typhoid Fever, P14,000.
Other medical conditions can be checked with PhilHealth affiliated establishments.
The new rates are applicable to all types of members (employed in the private and government sectors, lifetime members, overseas workers, and individually paying members and the sponsored program members).
NO BALANCE BILLING
Sponsored program members, those whose enrolment in PhilHealth are paid for by the national or local government units or by private individual and corporate sponsors, are also entitled to the “No Balance Billing” (NBB) policy for any of the case-rates in accredited government hospitals.
The NBB means that no other fees or expenses shall be charged or paid for by the patient-member above and beyond the packaged rates.
The NBB policy also applies when the Sponsored Program members avail themselves of outpatient surgeries, hemodialysis and radiotherapy in accredited non-hospital facilities such as free-standing dialysis centers and ambulatory surgical clinics.
It also applies to the existing outpatient packages for TB-DOTS, Malaria and HIV/AIDS.
All other member-types are also entitled to the NBB policy when availing of the Maternity Care Packages and the Newborn Care Package in accredited MCP (non-hospital) providers.
Share your Comments or Reactions
Powered by Facebook Comments
