The Philhealth 60 days

The Philhealth 60 days
The 60day period is considered as quiet to be a long time for those awaiting for PhilHealth refund, however, a number still fails to beat the prescriptive limit. Under the policy, filing for local confinement is within 60 days and 180 days for confinement abroad. Late claims are simply, denied.

This period is prescribed by the national health insurance law. Bonafide member and their dependents can automatically avail benefits from any of the accredited facilities after presenting eligibility standard to avail medical care attention.

Actually, PhilHealth unlike other insurances extends to patient all the Philhealth benefits outrightly. One needs not to wait the 60 day when he can immediately charge to PhilHealth certain in and out-patient hospital supplies and services.

The very essence of hospitals is to provide medical services including drugs, medicines and supplies, diagnostics, laboratory and medical procedures and equipment. It is not pleasing but there are facilities that are claiming for the room & board and doctor’s fee but failed to provide other benefit items required for medication. So, one has to buy items outside and later claim the reimbursement from PhilHealth.

Lack or limited supplies and services aside from delimiting and overpricing of stocks when one has to charge it to Philhealth have been an issue raised against our health care providers. However, we have to note that PhilHealth pay claims of outside bought items and services. The option to what facility or health care professional PhilHealth patient would sought for treatment is on member’s discretion. Member should only remember that he has to file his claim within 60 days.

A member should also determine what items with the corresponding amount deducted from his billing before paying the uncovered amount. The official receipts both from the facility and the attending doctor are need to be asked by the member so that he has the evidenced records of all the actual medical expenses including the benefits availed.

PhilHealth does not pay for all your health care costs. It pays only for covered items and services when its rules are met. Members usually give a co-payment for the portion of the actual cost that is not covered by PhilHealth. As to medicines rules set that they must be generic and/or included in the PNDF. It innovates to give a lee way that drugs, medicines, supplies and necessary laboratory procedures supported by official receipts dated 30 days prior to admission can now be reimbursed like those in hemodialysis, peritoneal dialysis, chemotherapy and other elective surgeries.

Our partner-health care providers from time to time are keep updated of the latest issuances and various activities have been undertaken to promote close coordination. We establish a mechanism feedback for PhilHealth clients to air their grievances against PhilHealth staff and/or any of its stakeholders. (Larry T. Tabsing)