Philippine Health Insurance Corp (PhilHealth) on Tuesday released a new case rate package for COVID-19 patients beginning April 15.
Ricardo Morales, PhilHealth President, and CEO noted that the government insurer had “sufficient” funds, it needed to impose COVID-19 rate package for sustainability.
Under the Universal Health Care Law, all Filipinos are covered by Philhealth. However, it has set a case rate package that determines the maximum amount the state insurer could shoulder for a particular illness. The patient will have to pay for the remaining balance through his own money or personal health insurance.
“The PhilHealth fund is sufficient, but it’s not unlimited. That’s why we have to exercise due prudence,” Morales said.
He said PhilHealth is currently covering all of the hospitalization and treatment costs for a coronavirus patient.
President Rodrigo Duterte, on Monday night, said PhilHealth benefits for COVID-19 cases would cover medical expenses ranging from P8,150 for testing to P786,834 for critical cases of pneumonia.
“The PhilHealth shall pay for all COVID-19 tests conducted outside hospitals or in nonhospital facilities, such as laboratories and drive-thrus, provided that the facilities are accredited by the Research Institute for Tropical Medicine,” Duterte said.
Morales said PhilHealth already paid P1.8 million to an unnamed hospital. Another hospital has a running bill of around P3.2 million, he added.
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Philhealth releases new rates for COVID-19 starting April 15
The new package categorized the coverage rates into four conditions of pneumonia, which is the most common and severe complication of the virus.
Patients with mild pneumonia will receive P43,997, P143,267 for moderate pneumonia, P333,519 for severe pneumonia, and P786,384 fro critical pneumonia.
The new rates will be enforced on April 15, which means that PhilHealth will still cover all costs incurred by patients hospitalized before that date.
However, some hospitals said they had not received any official notice from Philhealth regarding the new policies.
“We have not received any communication from PhilHealth that we’re not supposed to bill our patients right now,” VRP Medical Center director Dr. Veronica Regina Garcia said.
Morales acknowledged the information and instructed regional vice presidents and personnel to inform the hospital administrators under their jurisdictions.
PhilHealth has allocated P30 billion to pay hospitals that will claim reimbursements for patients covered by the state health insurance system.