Monday, August 1, 2011

Emailed Questions: PhilHealth Benefits for Outpatient Surgery

Would like to inquire what/how much are the benefits/rates I can get for the outpatient surgery from PhilHealth.

Surgeon, anesthesiologist, actual procedure, OR, etc.

I may need to undergo arthroscopic surgery.


Name withheld

We cannot give you the actual amount that you will receive from PhilHealth since it varies depending on a number of factors. However, you may use the benefit table here to compute for the approximate amount. Same PhilHealth benefits are being provided for all member categories.

Hope this helps.

PhilHealth 101

How about if I can be reimbursed even if the hospital is not yet accredited?

I read in the site:

What if the hospital is not accredited? Will I still get paid?

Claims of members confined in non-accredited hospitals shall not be compensated unless all of the following conditions are met:

Case is emergency as determined by PhilHealth

The hospital or facility has a current DOH license

Physical transfer/referral to an accredited facility is impossible as determined by PhilHealth.

The hospital PGH FMAB is still undergoing the Philhealth accreditation. Will I still be reimbursed even if they are not yet accredited?

If the hospital or doctor is not accredited PhilHealth may not reimburse the doctor's fee or the hospital charges. You can try to call the PhilHealth Office or call center for the status of the accreditation of your hospital or doctor. If you are to call the PhilHealth Office, directly look for the accreditation department and inquire the new accreditation period of your hospital. Moreover, if the hospital/doctor has submitted all required documents and PhilHealth approves the renewal, the start date of the accreditation period will be the date of submission of the document or the expiry date and since filing of the renewal application is before the expiration of the accreditation period, there is a chance of continuity of the accreditation and if this happens then you will be paid for hospital charges or professional fees.

PhilHealth 101

Note: Emailed questions may sometimes be edited for brevity and/or clarity.


  1. I was about 8-week pregnant when my OB-Gyne found out from an ultrasound that the baby had no heartbeat. She said I should have a DNC right on the same day and sent me to a hospital. Because it was an emergency and my safety was our foremost concern, my husband and I were not able to think of anything else, including our Philhealth benefits. The following day, we learned that my OB-Gyne failed to renew her Philhealth accreditation which expired January 2011. The hospital told my husband and my mother that they could not grant me my Philhealth benefit because of my OB-Gyne's non-renewal of accreditation. The hospital's accreditation was active, however, but the hospital cashier said that still I could not claim my benefits. Both hospital and physician should be accredited for a member to enjoy the benefit. We were so sad and dismayed. Please let us know if the hospital was right in denying my application for Philhealth claim. Thank you.

  2. You may directly ask PhilHealth by contacting the call center. As far as we know, only the packages under the case rate scheme is requiring that both hospital and doctor should be accredited. For pay to service scheme, you won't be able to claim PhilHealth benefits for the professional fee.