PhilHealth to reimburse fees regardless of hospitalization period
MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) will now reimburse members’ expenses for confinement due to 3 common diseases regardless of the number of days spent at the hospital.
PhilHealth Circular Number 2017-0028 removes the length-of-stay requirement for reimbursing claims of patients admitted to the hospital due to pneumonia, acute gastroenteritis, or urinary tract infection (UTI).
The circular was posted in PhilHealth’s website last October 14.
“Pursuant to PhilHealth Board Resolution Number 2215, s 2017, the Corporation shall no longer require the length of stay for claims application for community acquired pneumonia, acute gastroenteritis, and urinary tract infection,” reads the circular.
Instead, claims for the 3 diseases will be subjected to pre-payment medical review.
PhilHealth used to only cover the fees of pneumonia patients who were confined at the hospital for at least 4 days, while those with acute gastroenteritis must be admitted for at least 3 days before they could be covered.
Patients with UTI, meanwhile, used to be covered only if they were confined for a minimum of 96 hours.
Before the latest circular, failure to meet the minimum length of stay requirement would mean a patient would not be reimbursed by PhilHealth. – Rappler.com