Monday, April 20, 2009
Thursday, April 2, 2009
35% increase in PhilHealth Benefit Payment
MORE THAN 69 million members of Philippine Health Insurance Corporation (PhilHealth) nationwide will enjoy increase in in-patient care benefit ceilings for confinements starting April 5 this year.
"We have recognized the fact that rapid inflation has somehow reduced the significance of our existing benefit levels. There is an urgent need therefore to adjust our subsidies to meet the rising cost of hospitalization among our members," said Dr. Rey B. Aquino, PhilHealth President and CEO. Substantial increase in subsidies for hospitalization fees and professional charges of physicians, in response to the emerging and re-emerging of diseases and other health conditions in the country albeit the escalating cost of hospitalization, is expected to reach at 35 percent increase on annual benefit payments of the corporation.
In the 2009 revised in-patient benefit schedule, items such as subsidy for room and board, drugs and medicines, x-ray, laboratories and supplies and payment for professional fees of accredited physicians (including surgeons and anesthesiologists) have increased significantly, without any corresponding increase in premium contributions by members.
In the benefit item for room and board, confinement at the tertiary level hospitals will now have a subsidy of 500 pesos to 1,100 pesos per day depending on the case/type of illness as compared to the 400 pesos to 1,035 pesos subsidy. Though the increase in allowances for hospital room and board fees is moderate, a 260 percent increase in drugs and medicines for Case Type B in Primary Hospital is demonstrated, from P2,500.00 to P9,000.00 per single period of confinement. Such amount (P9,000.00) was then the maximum ceiling for drugs and medicines in Tertiary Level hospital under Case B category of illness. Rules on Philippine National Drug Formulary (PNDF), Antimicrobial Resistance Surveillance Program (ARSP) and rational drug use shall be observed.
With the new in-patient package, payment for x-ray, supplies, laboratory & other ancillary procedures grew as much as 76 percent. Additionally, maximum benefit for supplies and radiology, laboratory and ancillary procedures shall depend on hospital category and case type of illness and shall be covered by the rule on single period of confinement.
On the other hand, payment for operating room (OR), for patients undergoing surgical procedures will depend on the category of hospital and the RVU (Relative Value Unit) of the procedure. In the case of primary hospital, payment for OR is fixed at 500 pesos per use of operating room. However, P750.00 to a maximum of P7,500.00 OR fee shall be paid to ambulatory surgical clinics (ASC), freestanding dialysis centers and to hospitals depending on its category and RVU of the given procedure.
Further, maximum amount for professional fees both of the general practitioners and specialists combined rose up to 136 percent. "These benefits were increased in varying degrees across all case types (or illness types) as applicable, in participating tertiary, secondary and primary hospitals in the country," Aquino stressed. Likewise, consequent increase for anesthesiologist and surgeon's fees were also included based on PhilHealth's recently approved tiered payments for professional fees and the revised valuations for certain surgical and medical procedures.
Amid this significant move by the corporation to increase its benefits for in-patient care, its 1,500 partner hospitals are also called to continuously better their services and abstain from unnecessary jacking up of their fees so that PhilHealth members can fully enjoy these increases in benefits, added Aquino. (PRO VI-PAU)
Check Replacement
PhilHealth observed that several benefit payment checks are still under the name of the deceased member and members who are outside of the country, hence, cannot be encashed and consequently had staled.
“It’s only when proper and valid documents to support a claim for check replacement that we can change the payee of the check”, explained by Roberto Dais, PhilHealth in-charge for check replacement, “without such, the check is generated on the member’s name.”
The problem usually happens on claims of deceased member, who died while confined or after discharged from the hospital but with pending claims because of previous hospitalization.
The check can be changed to the new payee but rightful claimant must first comply with the needed requirements such as the member’s death certificate as well as member-claimant proof of relationship.
Priority is given to those listed as dependents in the Member Data Record (MDR), from spouse to any of the child/ren authorized by the other siblings and biological parents. If member has no direct heir, a collateral relative may proceed to claim.
As to members who are abroad, check usually stales because their spouse cannot claim the same. “Common reason is, they alleged to have no joint accounts in bank wherein the check could be deposited, so they just await for the return of their member-spouse”, Dais added.
Under PhilHealth policy, benefit payment check is generally issued to the member. And only under two conditions: when payee is deceased or is out of the country, that replacement is allowed to the legitimate claimant.
A Special Power of Attorney granting authority to do PhilHealth transactions is one of the easy proofs. In its absence, the rightful claimant must submit a request and proof of member’s status abroad. Claimant has still to provide valid identification, IDs of both member and claimant. PhilHealth noted certain cases that spurious claimant faked the documents in order to claim.PhilHealth Regional Office VI head Alberto C. Manduriao stressed that members who understand their rights and complied their responsibilities do not find difficulty in processing and claiming PhilHealth benefits. So PhilHealth encourages members and dependents to be informed of these.
Monday, January 19, 2009
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