Click to enlarge image.
Click to enlarge image.
The UNOFFICIAL blog to all things PhilHealth.
Showing posts with label outpatient. Show all posts
Showing posts with label outpatient. Show all posts
Tuesday, July 17, 2012
Saturday, April 14, 2012
Wednesday, August 17, 2011
PhilHealth Benefit Packages - Case Payment Rates
This post contains a list of benefit packages, under the case payment scheme, that are available to active PhilHealth members.
| Name of Benefit Package | Case Rate (Php) |
| Maternity Care Package (MCP) | 6,500.00 |
| Normal Spontaneous Delivery (NSD) Package | 6,500.00 |
| TB-DOTS Package | 4,000.00 |
| SARS Package | 50,000 - 100,000 |
| Avian Influenza Package | 50,000 - 100,000 |
| New Born Care Package (NCP) | 1,000.00 |
| Bilateral Tubal Ligation (BTL) Package | 4,000.00 |
| Vasectomy Package | 4,000.00 |
| Malaria Package | 600.00 |
| Influenza A (H1N1) Package | 75,000 - 100,000 |
| NSD with BLT Package | 10,500.00 |
| Outpatient HIV / AIDS Treatment Package | 30,000.00 |
| Dengue I (dengue fever and DHF Grades I and II)* | 8,000.00 |
| Dengue II (dengue hermorrhagic fever grades III and IV)* | 16,000.00 |
| Pneumonia I (moderate risk)* | 15,000.00 |
| Pneumonia II (high risk)* | 32,000.00 |
| Essential Hypertension* | 9,000.00 |
| Cerebral Infarction (CVA I)* | 28,000.00 |
| Cerebro - vascular Accident with Hemorrhage (CVA II)* | 38,000.00 |
| Acute Gastroenteritis (AGE)* | 6,000.00 |
| Typhoid Fever* | 14,000.00 |
| Asthma* | 9,000.00 |
| Cesarian Section (CS)* | 19,000.00 |
| Dilatation and Curettage (D&C)* | 11,000.00 |
| Hysterectomy* | 30,000.00 |
| Mastectomy* | 22,000.00 |
| Appendectomy* | 24,000.00 |
| Cholecystectomy* | 31,000.00 |
| Herniorrhaphy* | 21,000.00 |
| Thyroidectomy* | 31,000.00 |
| Radiotherapy* | 3,000.00 |
| Hemodialysis* | 4,000.00 |
| Cataract Package* | 16,000.00 |
* PhilHealth will be directly paying the health care facility inclusive of the professional fee, hence, this is directly deducted to the bill of the eligible PhilHealth member. Will also take effect for claims with admission date September 1, 2011.
This list will be updated once additional benefit packages become available. We shall also be discussing each of these packages in detail in succeeding posts so stay tuned.
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.
Thanks.
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 http://www.philhealth.gov.ph/forms/others/lifetime_benefits.pdf 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.
Surgeon, anesthesiologist, actual procedure, OR, etc.
I may need to undergo arthroscopic surgery.
Thanks.
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 http://www.philhealth.gov.ph/forms/others/lifetime_benefits.pdf 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.
Subscribe to:
Posts (Atom)