Philhealth Benefits — Medical and Surgical Cases to be Paid on Case Rate Basis

Matagal nang proposal ng Philippine Health Insurance Corp.  (PHILHEALTH or PHIC) ang pagbabayad ng 22 medical and surgical cases on a Case-Rate Basis, at hindi na on a Fee-for-Service basis.  Ibig sabihin, magkakaroon nang fixed Philhealth payment for each of the 22 cases, kahit saang accredited hospital, kahit sinong accredited doctor, at kahit ilang araw ang hospitalization or treatment.

Itong 22 cases ang pinakamadalas na binabayaran ng Philhealth for the past several years. Almost 50 percent daw ng Philhealth claims ay itong mga 22 cases na ito.

Proposal pa lang ito, at pinag-uusapan pa ng Philhealth board. According to some press releases, this Case-Rate-Basis will be implemented SOON.

UPDATE:   Philhealth has already announced that it will start implementing the Case Rates Payment scheme for hospital/clinic admissions starting September 1, 2011.  Certain proposed rates have been increased.  The amounts in blue color are the final rates.

Another UPDATE:  Philhealth announced that the Case Rates payments for surgical cases are applied to hospitalizations in Levels 2, 3 and 4 hospitals only (bigger hospitals),  except for certain cases.

These are the surgical and medical cases, and the corresponding fixed rates or payments/reimbursements by Philhealth.

Medical Cases:

1.  Dengue Fever and DHF Grades 1 and 2  —  8,000 pesos
2.  DHF Grades 3 and 4  —  16,000
3.  Pneumonia 1  —  15,000
4.  Pneumonia 2  —  32,000
5.  Essential hypertension  —  9,000
6.  Cerebral infarction (CVA I)  —  28,000
7.  Cerebro-vascular accident hemorrhage (CVA II)  —  38,000
8.  Acute gastroenteritis (AGE)  —  6,000
9.  Asthma  —  9,000
10.  Typhoid fever  —  14,000
11.  Newborn care package (NCP)  — 1,000  —  increased to 1,750

Surgical Cases:

1.  Radiotherapy  —  3,000 pesos
2.  Hemodialysis  —  4,000
3.  Normal delivery or maternity care package (MCP) in maternity or lying-in clinics  —  8,000

Normal spontaneous delivery (NSD) in Level 1 hospitals  —  8,000
Normal spontaneous delivery (NSD) Levels 2 to 4 hospitals  —  6,500

4.  Delivery by caesarian section (CS)  —  15,000 — increased to 19,000
5.  Appendectomy  —  26,000 — decreased to 24,000
6.  Cholecystectomy  —  31,000
7.  Hysterectomy  —  30,000
8.  Dilatation and curettage  —  11,000
9.  Thyroidectomy  —  31,000
10.  Herniorrhapy — 21,000
11.  Mastectomy  —  22,000

* Note:  For SURGERIES, the Case Rates payment will apply only to cases managed in Levels 2 to 4 hospitals, with certain exceptions.

According to Philhealth, the advantages of Case-Rate-Basis are the following:
– Fixed payments regardless of hospital size and length of treatment
– No more itemization of costs
– Reduction in claim processing costs
– Faster payment of claims
– Lower financial risk for Philhealth
– Reduction of fraud risk

This proposed Philhealth program is also called No Balance Bill Policy because it seeks to cover the full costs of the medical and surgical procedures in accredited government hospitals. Ang gusto nilang mangyari ay lalabas ang pasyente na walang babayaran sa government hospital na Philhealth-accredited.

Updated: August 31, 2011 — 10:53 pm

491 Comments

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  1. Good day.
    Tanong ko lang po. I have a newborn daughter (22 days old) who is now confined due to pneumonia. magkano kaya maging discount namin sa hospital. maka avail pa ba kami ngayon since bago lang kami nakagamit during sa panganak ng misis ko.
    Salamat po and God bless to all.

      1. hi ofw po kmi ung asawa ko my hyperthyroid binigyan lang po sya ng doctor ng gamot for anti thyroid at pinababalik po kmi sa july hindi nman po ooperahan prang lulusawin lng daw po. kapag po b my philhealth magkano ma didiscount its a private hospital po?thank you!

        1. Hi riza, hindi ko alam kung anong tawag sa procedure na gagawin, so hindi ko ma-check kung meron ang procedure na yan sa Case Rate list. Ang coverage for hyperthyroidism is 8,500 (2550 for PF; 5950 for hospital), pero hindi ko alam kung ito yong coverage for the treatment that will be performed.

          1. My wife will have radioactive treatment for hyperthyroidism in march 2015. Is there a benefit from philhealth? How much is the benefit? Our doctor told us to prepare 20th

  2. tanong ko lang po seaman po ang asawa ko mag pasurgery po ako ng thyroid nxt week sabi po sa akin 120k po lahat ang tanong ko po magkano po ang mababawas dun ng philhealth thanks po

    1. Hi mel, will you undergo thyroidectomy? Removal of the thyroid gland or part of the gland? If it is, Philhealth coverage is 31k. 18600 for the hospital, 12400 for the doctor.

  3. Good day! My daughter was confined for pneumonia sometime in October 2011 to a community hospital. I had a private Philhealth accredited doctor but all the medicines were purchased outside the hospital amounting to more than 3, 000 pesos with receipts submitted to the hospital for reimbursement. The BPN said that the hospital was paid 15, 000 for my daughter’s case. Total amount of hospital bill was 3, 445 in which 2, 945 was deducted from as a result oh Philhealth benefits. I only received the reimburesed amount of medicines and laboratory with barely 903 pesos last February 14, 2013. I asked why too little, yun daw and assessment ng pharmacist. Ganun po ba talaga?

    1. Hi Cristina, do you mean you spent 3k+ pesos for medicines and paid 500 to the hospital (3445-2945)? And Philhealth paid the hospital 15k. The hospital should refund you 500 pesos plus the 3k+ you spent for medicines. The hospital was paid under Case Rate, so they should consider all the medicines purchased. Philhealth did not reject any medicine you purchased since it’s Case Rate, so why should the hospital do so? I suggest you show again your BPN (keep a copy for yourself) and ask for additional refund.

  4. Hi good am, nag inquire ako sa lying in kung magkano ang NSD nila sabi around 6500-7000 hindi kasali ang new born babayaran separately pati yung first vacine, then tinanung ko kung magkanu ang magiging deduction ng philhealth ko dun sa sa 6500-7000 bill nila, sabi ng dr. 40% daw, so kung 7000 less 40& 4200 ang babayaran ko, eh nakalagay dun sa bracket nyo pag level 1 6500 ang dapat na maging share sa akin ng philhealth, baki 2800 lang ang sinasabi sa akin ng OB and ibabayad ko ng hiwalay yung Newborn and first vacine. Anu poi bang gagawin ko?

    1. Hi Alison, I’m not sure why many health facilities (even the big hospitals) do not comply with the correct amount of deductions. Maybe they need the cash, or maybe Philhealth takes a long time in paying them. If you like, you can try asking if they will help you with the Philhealth papers if you pay in cash, so you can get the refund in full. But you have to wait for many months. And sometimes the check or the mail gets lost, as some who are commenting here say. Please ask others too.

  5. Hi good am yung husband ko both member kami ng philhealth na admit at naaooperahan sa isang private clinic regarding sa malaking ceast pero out patient sya, umuwi rin kami pagkatapos nya operahan HMO member din sya, wala kaming ginastos sa ospital at treatment.. pwede ba naming ireemberse yung mga binili naming gamot sa labas ang mamahal kasi ng mga niresatang antibiotic, pede ba naming ireembers yun? anung requirements? last January 27,2013 lang sya naoperahan. tnx

    1. Hi Alison, what I know is that medicines are only covered by Philhealth if they’re used while in the hospital or during surgery. Please ask others too.

  6. Good day, Inquire ko lang both member kami ng husband ko sa philhealt, last January 27, 2013 naaperahan sya sa malaking clinic out patient kami, so nakauwi din kami after ng operation wala kaming ginastos kahit piso during operation kasi HMO member din sya, inquire ko lang pwede ba naming mareimbuse yung mga gamot na binili nmin sa labas na required nya inumin.. ang mamahal kasi ng mga niresatang antibiotics, If ever na pwede mareemburse anung requirements ang kailangan namin isubmit sa clinic na pinag operahan sa kanya philhealth accredited din yun clinic. tnx

  7. Good day po..I am above 10 years phlhealth member & only once avail the benefits during my CS-birth last 2010. And my second availment was last October, when my son confined at the semi public hospital for pneumonia case w/ acute exacerbation.Since we arrive late evening at the emergency room,we cashed out those medicines being told us to purchase & even the x-ray and other laboratory because there is no one can issue “phlhealth monitoring slip” (a requirement asked by their pharmacy in every phlhealth member) at the said hospital. We stayed at their service ward for six days.Estimated worth of medicines being charged to phlhealth was near 3k & laboratories @ 2k since most of the med used were salbutamol & generic antibiotics but when we go out at the hospital, we paid 9oo+ & we did not received any refund until now although we submitted the cashed out receipts to them that worth 5k. And as i saw at the hospital bill,why they charged us a doctor fee of 4500 each, i thought it was free when u are in service & why 1100/day for room since we stayed at the service ward where almost 20 patients who shared the poorest room. Please help me understand.thank you.

    1. Hi vonz, how much was your total bill? And how much did you pay the hospital? Have you received the benefit payment notice (BPN) from Philhealth? This will show how much Philhealth paid the hospital. Xerox this BPN, and keep copies, and then ask for refund from the hospital. Did you pay the room rate of 1100 per day? Is this really their room rate for wards? This is a rate for semi-private rooms in other hospitals.

  8. hi ask ko lang dependent ako ng mom ko sa philhealth so gagamitin nmn ung for maternal case ko then my philhealth din ako pero hnd ko natuloy pag hulog pwede bang i dependent ko ung baby ko sa philhealth ko pero sa mom ko muna iaawas ung kakulangan? tnx.

    1. Hi Grace, I think if you want your baby to be covered, it should be your membership that should be used for both maternity and newborn, because you can not be a dependent and at the same time a member. But you have to fix your eligibility first, make the required payments.
      If you can no longer complete your eligibility as a member because you’re already late, you have to use your mother’s membership, with you as her dependent. And it will only be for maternity. Ask others too. take care

  9. my mother have been operated for cataract last january 15, 2013 and we did’nt claim philhealth
    because my mdr is not yet updated can i still claim
    the 16,000 allowed to be deducted by philhealth

    1. Hi anna, yes, you’re still within the 60-day claim period. Obtain signed claim forms from your doctor/hospital. The new rule about the need for Philhealth authorization before cataract surgery is effective on February 1, so your case is not yet affected by this rule.

  10. good day po. ask ko lng po kung kasama ang cataract surgery sa cases na saklaw po ng philhealth. thank you very much po

    1. Hi jack, yes, covered ang cataract treatment. But you must ask your doctor first because Philhealth requires a pre-approval of cataract treatment before the actual operation takes place.

    1. Hi shiela, yes, most outpatient surgeries are covered, as long as they’re not for diagnostic purposes. It also depends on your surgeon, so ask your surgeon.

      1. good pm po, ask ko lng po kung magkano ang male-less ko sa bill namin sa hospital kung gagamitin ko ang philhealth ko, na compign po ang special child ko na anak sa private hospital, meron po syang microcephaly, 1 week po sya sa icu and morethan 1 week po sa private room, nasa 120k po bill ko sa hospital and almost 120k din po sa mga doctors fee, nasa po mtulungan nyo po ako sa question ko, tnx po

        1. Hi ferdinand, I’m so sorry that Philhealth deduction is not based on actual hospital cost, but based on the fixed rates listed by Philhealth for each illness and treatment done. Go to the accounting/collection dept and ask your Philhealth deduction. In the Medical Case rate list, the coverage for microcephaly is only 13k, but there could be coverage for the major treatment done.

  11. gud evening po, ask ko lang, if nag stop po ako ng payment sa philhealth last year, then nagtuloy po ako this year..pwde ko po ba xa magamit this year? if nakaka 6months pa lang po ng hulog sa philhealth, kasi nag stop ng hulog last year..pwde pa din po xa magamit and how much po kaya ang pwde ibawas if i have to undergo thyroidectomy?
    thank you po.

    1. Hi Claire, check if you have paid 9 of the past 12 months (12 months BEFORE month of surgery). If yes, your thyroidectomy can be covered at an accredited hospital and doctor. Coverage for thyroidectomy is 31k (18,600 for hospital and 12,400 for PF). Ask your surgeon too.

  12. hi! po asked ko lang po mag 2 years pa lang ako member ng philhealth, then nagamit ko sa anak ko ng naconfined sya because of acute bronchitis this jan 2013 lang and this coming May 2013 manganganak naman ako cs ako magagamit ko ba ulit ang philhealth ko and sure ba 19,000 ang deductions sa level 2 hospital?

    1. Hi sha, yes, you can avail of your maternity benefit. What is not covered for the 2nd time is the same person with the same illness within 90 days. Yes, your CS coverage is 19k (11400 for hospital cost and 7600 for the doctors). It should be Indicated CS, meaning it’s your doctor that decides. Yes, it’s covered in a level 2 Philhealth-accredited hospital by an accredited doctor. In some hospitals, they deduct only 11400 and you refund the 7600 later on.

  13. hi everyone i hope you can help me answer my question regarding philhealth..I have a bro-in-law needing a surgery to remove kidney stone.The procedure called laser wave shock. My sis said that they have a philhealth insurance. How much discount they will save for this procedure? What are the services covered with philhealth? Im live in the US but im not sure how this philhealth insurance works. Thanks a lot.

    1. Hi alice, sorry, that procedure is not under the Case Rate scheme, so the benefit is not fixed, so I cannot give you the exact amount. It would be covered under the fee-for-service system, in which benefits for room, OR, meds, PF, lab have limits depending on hospital level and illness severity. Your sis needs to ask their surgeon about Philhealth before surgery.

      1. hi, is there a website that explains fee-for-service system ng philhealth. my wife is due for surgery also on kidney stone sa NKTI (Tertiary hospital). need to know how philhealth will do the calculations po. thanks and more power!

  14. Good day, In Nov 2011 I undergo Open Heart Surgery (PHC).Sa bill namin na 350k philhealth deduct 33k. May 2012, I received a check(refund)amounting to 27k.

    After a year, I got pregnant and since high risk pregnancy we paid 140k, nadeduct lang is 11k since package daw un sa CS,

    Ask ko lang my makukuha paba ako na na refund?same sa operation ko?

    1. Hi karen, you should be able to refund 8k from the hospital after you receive your benefit notice from Philhealth. The coverage for CS is 19k (11,400 for hospital and 7,600 for doctors). Xerox your hospital receipt and benefit notice so you have copies.

  15. Good Day!
    I was admitted this month at a govt hospital here in our place for hysterectomy. most of my medication were bought outside the hospital and my bill was only 5,360. When I submitted the Ors to the hospital clerk, she refused to attach it to the claim since it will not be refunded. I further asked for her explanation because this is unfair for my part that they will be paid far more than what they have provided. she said they also cannot reimburse the medications that i have purchased outside since the money that Philhealth will pay will directly go to the province and they cannot easily dispense money of the hospital. Please help me with this situation. thank you!

    1. Hi nikki, the coverage for hysterectomy is 30k, further allocated as 18k for hospital costs and 12k for the doctors. Did you pay the 5,360? It’s good they did not accept your receipts, so you still have your receipts with you. They don’t need the receipts for their Philhealth filing because hysterectomy is under Case Rate — has fixed rate. Wait for your benefit notice from Philhealth and then when you get it, xerox it (also your receipts) and go to the hospital and ask for your refund.

  16. Hello! I have myoma that needs to be removed through abdominal myomectomy. Can i check with you how much can i claim from Philhealth for this case? Can the claim be automatically deducted from the hospital bills or i have to wait for reimbursement? Thank you so much for being helpful. – angie

    1. Hi Nelita, that procedure is not in the Case Rate list, so the coverage is not fixed, so, am sorry, I can’t give you the coverage amount. Your case will be covered under the old Fee-for-Service scheme — you have coverage for room, OR, PF, medicines with maximum limits, based on hospital and treatment category. Submit your complete documents before discharge, so your Philhealth coverage will be deducted outright.

  17. Hi, ask ko lang if My marefund kmi n doctors fee Worth 30k,di daw accredited ng philhealth ung doctor. And why 24k ang charge nila sa PHILHEALTH for the hospital bill Eh 2days n 2nights lng sya s hospital tpos hiwalay p ung doctors fee.
    Thanks

    1. Hi judi, what surgery was performed? Appendectomy? If yes, 14,400 (24k x 60%) should have been deducted from the hospital bill. Why is the hospital able to deduct Philhealth if the doctor is not accredited? Was there an accredited doctor who helped the main doctor? If so, then 9,600 (24k x 40%) should have been deducted from the doctors’ fees.
      If the treatment or illness is under the Case Rate scheme, Philhealth gives the full coverage amount to the hospital, whether the full amount was used or spent for the patient or not.

    1. Hi Tony, it’s 16k for both eyes if done for both eyes at one time. 16k for each eye, if done separately and in certain cases. Just ask your doctor about the difference. Starting May 2013, this coverage needs approval from Philhealth before it’s performed.

  18. hello gud pm po,,wla po akong work pero active member po ako ng philhealth 2 years napo,,buntis po ako ngayon 8 months napo 1st baby,,at manganganak po sa st. martin hospital ng san juan,public lang po.ang tanong ko po pano po ako makakaavail ng malaking discount kung halimbawang normal delivery po ako at kung sakaling cs naman po ako?bale magiging single parent po ako,hindi ko po kasi alam kung pano kalakaran kung ano po ba dapat kong unahin or aasikasuhin tulad ng pag normal delivery po ba or cs then pano kung ang ibang gamot ay hindi available sa hospital sympre bibili po ako sa labas ano po gagawin ko para marefund ko po yung nagastos ko sa gamot at sa bill ko sa hospital?

    1. Hi lin, it’s sad but usually at government hospitals, patients buy medicines and supplies for their treatment even if they have Philhealth. Just be ready with your MDR, premium receipts and IDs and keep the receipts of whatever you buy outside. You can refund these later on after you receive your benefit payment notice from Philhealth. So be ready with some money for medicines and supplies and have someone with you who will buy medicines. You can also ask the hospital about how much you will spend if you have Philhealth

  19. hi i have an concern, almost 9year napo akong member ng philhealth.my question is tuwing nag prenatal po ako dito sa ibang bansa kasi OFW po ako.pwedi kopo ba ma-refund ang mga nagastus ko sa mga nagastus ko dito sa pre-natal ko.o yung mga vit.vacine na sinagawa dito. at ito bay may limit na ilan buwan valid. at mga ilan buwan po bago namin makuha ag refund nyo.thank you nad god Bless u……..

    1. Hi Jane, you can claim only for your most recent prenatal expenses up to 1500 pesos; you include your receipts worth at least 1500 in your maternity claim. Claiming for overseas hospitalization is within 180 days. For local hospitalization, claiming should be within 60 days. Claim processing can take from 3 to 5 or more months.

  20. HI
    My wife had caesarian delivery last Sept.2011
    we’ve paid 25k for professional fee and almost
    7k for hospital bill.When we ff-up for the refund they told us we cannot avail refund kasi daw package daw po.is it possible?
    thanks.

    1. Hi Gil, did you submit Philhealth documents in Sep 2011? Because claim filing should be within 60 days after discharge. Did you receive a benefit payment notice from Philhealth? “Package” is only possible if they explained it clearly to you before your wife had CS there, and you consented — like they asked you something like “okay, you will pay only 7k amount for the hospital and 25k for PF, and Philhealth will take care of the other expenses.” Did that happen?

  21. My wife had a gall bladder operation, I paid all the bills in cash including the private doctor, I finally refunded 18,600 pesos from the hospital bills, do I have to claim refund of 12,400 pesos also to the doctor, because I already paid him in cash the doctor’s bill? As it is mentioned that Gallbladder operation is 31,000 pesos. More power to Philhealth!

    1. Hi Francisco, yes, you should be able to refund 12,400 from the doctor (if he got the separate PF check from Philhealth) or from the hospital (if the 31k check was sent to the hospital). The hospital’s accounting/collection dept should be able to advise you about it.

  22. Hi…nakaschedule po ako for thyroidectomy private doctor level 2 hospital gagawin sabi ng brother ko mas maganda kung i package deal na lang para wala na kaming poproblemahin sa lahat yun doctor na rin ang magaasikaso ng philhealth wala ako idea mga ganitong bagay…. ibig sabihin ba nun yung babayaran namin kung magkano man yon kasama na yung philhealth….mas mainam ba yun o wag na lang namin i package deal…thank

    1. Hi ann, it would depend on the package deal. The advantage of a package deal is you already know the exact amount you will pay. Or you already know that you will not pay anything, if that’s the agreement. Just make sure that everything is clear, that hospital costs, meds, supplies and all professional fees are included in the package deal. The Philhealth coverage for thyroidectomy is 31k (18600 for hospital and 12400 for PF), so if this is enough for your operation, and you won’t pay anything, or you add just a little, then that’s good.

  23. hi…tinanong q yung doctor na gagawa ng thyroidectomy kung magkano magagasta namin sa ask nya kung may philhealth sabii q meron mga 25k daw prepare q nakapackage deal kc kami…. yung 25k na babayaran namin …kinaltas na ba yung sa philhealth q dun?

    1. Hi ann, I wish you asked the doctor. But based on the flow of your conversation, I think you need to prepare 25k. I guess the cost in that hospital with your doctor for those without Philhealth is about 56k. So 56k minus 31k (Philhealth coverage) = 25k. But I’m not sure. You should ask the doctor. If you’re shy about asking the doctor again, you can ask the accounting/collection of that hospital the cost of thyroidectomy for those with and without Philhealth.

  24. kanina nag punta aq sa philhealth office para kumuha ng MDR para maayos na lumabas inactive member daw aq eh monthly naman ako pinagbabayad kahit nung nasa private school me nagtuturo hanggang sa ngayon na nasa government na aq…di ba e2 centralized kc nagfile aq sa bulacan sa manila aq nagtuturo dun public sch. kailangan ko pa ba tlagang magpapirma ng Er2 para maayos yun ….di ba magagamit yung philhealth kung d q pa maayos bi4 my operation which schedule on tuesday ?..thank you in advance

    1. Hi ann, Philhealth has centralized records. It could be that your school is late in remitting Philhealth payments. If you cannot show the hospital your updated MDR, the hospital will not make outright deductions. You need to get certification of premium payments from your school including OR nos. for at least 3 of the past 6 months. If you can’t give the hospital the required documents, get your signed claim forms plus surgical records plus bill payment OR from the hospital before leaving the hospital so you will file directly with Philhealth. If you plan to return to the hospital to get the forms at a later date, it’s often difficult to find the doctors for signing of forms.
      Also, you will wait for months for the refund.

  25. hi…goodday po nagthyroidectomy po aq nakapackage deal kami sa doc. nasa bill namin 41075.94 less kasama yung philhealth nagbayad kami ng 15.000 sa hospital bale nasa 26.0000 yung philhealth kung pagbabasehan yung case rate ng thyroidectomy na 31k ang cover ng operation q ask q lang possible ba na may marefund pa aq?…tnx po

    1. Hi ann, it depends on the doctor and your agreement since this is a deal. The difference of 5k (31k – 26k) will go to the doctor, since your 26k deduction exceeded that allotted for the hospital (18600). If your package deal went something like this: “Okay, just pay 15k, submit your Philhealth documents, and we’ll take care of the rest”, it means your total expense is 15k. Ask the doctor or the hospital. Or after receiving your benefit payment notice from Philhealth, you can go to the hospital and ask for your refund.

    2. Hi ann, it depends on the doctor and your agreement since this is a deal. The difference of 5k (31k – 26k) will go to the doctor, since your 26k deduction exceeded that allotted for the hospital (18600). If your package deal went something like this: “Okay, just pay 15k, submit your Philhealth documents, and we’ll take care of the rest”, it means your total expense is 15k and the doctor might no longer refund the 5k. But ask the doctor or the hospital. Or after receiving your benefit payment notice from Philhealth, you can go to the hospital and ask for your refund.

    3. Hi ann, it depends on the doctor and your agreement since this is a deal. The difference of 5k (31k – 26k) will go to the doctor, since your 26k deduction exceeded that allotted for the hospital (18600). If your package deal went something like this: “Okay, just pay 15k, submit your Philhealth documents, and we’ll take care of the rest”, it means your total expense is 15k. Is this the same doctor who initially quoted 25k? If yes, then you got a good deal. But ask the doctor or the hospital. Or after receiving your benefit payment notice from Philhealth, you can go to the hospital and ask for your refund.

    4. Hi ann, it depends on the doctor and your agreement since this is a deal. The difference of 5k (31k – 26k) will most likely go to the doctor, since your 26k deduction exceeded that allotted for the hospital (18600). If your package deal went something like this: “Okay, just pay 15k, submit your Philhealth documents, and we’ll take care of the rest”, it means your total expense is 15k. Is this the same doctor who initially quoted 25k? If yes, then you got a good deal. But ask the doctor or the hospital. Or after receiving your benefit payment notice from Philhealth, you can go to the hospital and ask for your refund.

  26. Sir
    ask q yng case ng anak q kng coverd ang gamot na factor 8 nya na ginagamit, hemophilia ang sakit nya and he was admitted last two weeks at ust mla for 4days.
    Slmt,

    1. Hi rodito, sorry po, kung ang gamot ay bibilhin at gagamitin outside the hospital, it’s not covered by Philhealth. But there’s also the 90-day rule ang Philhealth so hindi rin covered ang the same cause of hospitalization within 90 days. I hope lang na maraming susulat sa Philhealth at hingin na isali sa factor infusion ang outpatient coverage kagaya ng coverage ng hemodialysis. You can go to PCSO and ask assistance. Sa unang request, parang maraming docs required, pero later on, pag nasanay na, alam mo na ang pasikot-sikot. Go there as early as 5 am.
      Letter Request to Chairman/General Manager
      Medical Abstract
      Bill/Quotation/Costing from Hospital Pharmacy/Supplies
      Laboratory Request/Medicine Prescription
      Endorsement/Acceptance letter from Hospital Social Services/Credit Collection Office
      Paano hihingi ng tulong sa PCSO?

  27. hi, naka schedule po nanay ko for gall bladder operation, magkano po ba ang makukuha namin sa philhealth nya?

    1. Hi Menjie, is this removal of the gallbladder? Is the procedure called cholecystectomy? If yes, the coverage is 31k (18,600 for the hospital and 12,400 for the doctors). The hospital should be level 2 to 4.

  28. Hi po,

    Please let me know how much will be covered by philhealth for my mother’s gall bladder operation?
    Thanks po.

    1. Hi Tata, sorry I’m not a doctor, so I looked up for the definition of herniaplasty, and it’s the same as herniorrhaphy — which is covered under Case Rate. The coverage is 21k (12600 for hospital cost and 8400 doctor’s fee).

    1. Hi k.ann, tonsillectomy is not in the Case Rate list, so I can’t give you the exact rate. It will be covered under the old scheme. There will be benefits for meds, room, lab, OR, PF with maximum limits, depending on hospital category and doctor’s specialty.

  29. Good day. I’d like to ask if a hospital can refuse Philhealth deduction from billing because they classified our mother as being released from ICU against the doctor’s advice, even if the doctor told us that he agrees with our decision to pull her out of ICU, and that her case was terminal. She could only live through a respirator and would not recover to her normal self. When I checked the Philhealth regulations, it doesn’t say anywhere that we would be refused deductions under such conditions. Please help. Thank you very much po.

    1. Hi CJ, yes, I think so too that one cannot be refused Philhealth deduction due to that reason…unless the illness code and category that would be written by the doctor on the claim forms require ICU treatment. I’m not very sure but I think it has something to do with the need for the doctor to describe the diagnosis and treatments done and the illness code, with lab results that support the diagnosis and treatments.
      Talk with the hospital again and ask what Philhealth rule is being violated by a transfer from ICU to regular room. You can also call Philhealth.

    1. Hi j-ar, sorry but these are diagnostic procedures and if they are done as outpatient, they are not covered. These are covered if they’re performed while you’re being treated during hospitalization. Please ask others too.

  30. hi can i ask if i can use my philhealth even if im inactive because i didnt pay my contribution last year up to now.im planning to pay it this time before i will undergo CS on september but i paid 12months before i became inactive.

    1. Hi judy, what you can pay this month are April to Aug and these count to only 5 months — You need 9 monthly payments to qualify for maternity benefit (9 of the 12 months before month of delivery). If you like, you can ask Philhealth if they’re offering again their Individual Policy Contract- you might qualify.

  31. hi can i ask kung paano po yung sa case ko.. may gallstone po ksi ako so by saturday june 1, 2013 nka schedule ako for operation sa Manila Doctors cover po ng medicard yung operation ko ano po ang macocontribute ng philhealth since member ako nito…

    1. Hi Carlina, did Medicard tell you they will cover everything? What I know is that HMOs do not pay the portion covered by Philhealth, so they require members to submit Philhealth papers to the hospital before discharge.

  32. good day po..nanganak yong asawa ko last may 19,2013 sa ospital ng muntinlupa kaso yong baby ko nagkaroon ng problema na diagnosis ng live term female nsd aga,clinical sepsis kaya inabot ng one week bago nakalabas ng hospital sabi ng osmun kailangan e file ko muna baby ko sa philhealth para mabigyan ng discount kasi nauna yong asawa ko e discharge binigyan lang ng P5,000 na discount yon na daw maximum na binibigay ng philhealth pati new born screening at hearing test babayaran pa namin inipon ko pa naman mga resibo na binili ng gamot sa labas sabi nila hindi na daw kailangan kasi P5000 lang maximum pag normal delivery.tama po ba ang procedure na ito sa ospital ng muntinlupa?

  33. hi good day…nanganak ang asawa ko last may 19 sa ospital ng muntinlupa normal delivery after 2 days nakalabas na binigyan nila ng philhealth discount na P5,000 lang kaso yong baby ko naiwan kasi na diagnos ng live term female nsd aga,clinical sepsis inabot ng one week bago nakalabas inabot ng P10,843.75 bill hindi pa kasama mga gamot na pinabili nila sa labas mga almost P5000 din hiwalay din namin babayaran new born screening test at hearing test lumapit ako sa philhealth sa billing section nila ang sabi file ko muna daw ang baby ko sa philhealth para mabigyan ng discount at magpasa ako ulit ng requirment para sa baby ko hindi ba kasama baby sa discount ayaw din nila ibigay yong P1,750 para sa pre natal.tama po ba ang procedure na ito sa ospital ng muntinlupa?ano po ang dapat kong gawin para may makuha ako ng refund sa philhealth?

    1. Hi aaron, dapat kinuha nila yong prenatal ORs nio at isinama nila sa maternity claim; it would be Philhealth that will send you the 1500 refund via a check. For the newborn care package, you need to submit another claim form 1. Puede ka namang pinapirma na doon sana.
      For the sepsis treatment, dahil nabayaran nio na ang hospital, I suggest you file directly at Philhealth. Get your accomplished claim forms from the hospital and then file together with your MDR, Philhealth premium receipt, birth certificate, ORs of payments made to the hospital and ORs of meds bought outside the hospital. Dalhin mo na rin ang IDs mo and marriage certificate baka lang hanapin. Dalhin mo na rin yong prenatal ORs nio at tanungin kung paano i-file dahil hindi kinuha ng OSMUN. Maaaring sabihin nila na antayin nio ang benefit payment notice (yong sa maternity claim) and then mag-re-file at isama na ang prenatal ORs. Kung sabihin nila ito, ask them kung ok lang bang mag-re-file by that time na lumampas na sa 60-day filing deadline. Please ask others too because I might have missed some things.

  34. Good day!Isa po akong OFW ,tanong ko lng po sna kung covered ba ng PHILHEALTH ang circumcision pra sa anak ko n 3 yr old,nagkaroon po kc xa ng bukol kya sabi ng doctor sa PGH circumcision nga pra mtanggal un.magkano po kya ang babayran ko?maraming salamat po.

    1. Hi zehavit, considered day surgery ang circumcision, at wala siya sa Case Rate list, so I cannot give the exact rate. Dapat tanungin nio agad yong PGH doctor kung puede niong gamitin ang Philhealth because he will need to fill up Philhealth forms.

  35. tnx for your response.. actually they inform me na they cover maximum 64000 including doctors PF for my surgeon for the anesthetiology board and room medicine etc. they try to give me an example if i prepare to choose semiprivate room the possible charge is 36,000 for the rest except the Operation Cost if i choose Ward possible price is 34,000 if you less this following no. to 64000 i almost have 25000 left more or less. Now i just wondering if how much yung ishoshoulder ng philhealth in my case kung ang gagawin na operation sa akin is Open Minilap Cholecystectomy…
    Ksi na advice ako na kung lalagpas ako sa binigy ng medicard na limit of 64000 ako na ang mgbabayd the rest ng bill … i dont habe enough cash especially hndi ko toh napaghandaan .. hndi nman ako mbgyan ng linaw kung nsa mgkano ang total cost ng operating procedure na yun .. one more anong level ba ang Manila Doctors Hospital .. ksali ba sia sa level 2 up to 4 ..tnx more power

    1. Hi Carlina, ask your doctor if your cholecystectomy is the type covered for 31k by Philhealth under Case Rate. If it is, then your Philhealth coverage is 31k (18600 for hospital and 12400 for PF). You should talk with your doctors and ask their total PF and the total surgery cost, so you can also decide which room type to stay — siguro alam mo naman na sumusunod sa room type ang PF. Dapat ma-estimate nila yan, kasi nagpe-perform na sila niyan. Para zero cash-out ka. At dapat Medicard-accredited ang doctors,di ba? Manila Doctors is Level 4, so your surgery is covered by Philhealth. Bring your Philhealth documents para madeduct agad ang Philhealth.

  36. sir i actually talk to someone who is philhealth representative at Manila Doctors she advise me na af macocover nga ng Philhealth is depende sa ilalagay ni Doc na RVS Code sa CF2 … by package daw ksi yun at nakadepende sa hospital.. Regarding naman sa room ang pinili ko po is ward it cost 700 a day … i actually ask the operating attendant if how much yung estimated cost or range ng Open Minilap Cholecystectomy Operation and they say na it range from 25000 to 30000 .. and dun pa ako nag base sa mga answer nila.. hopefully na they gave me the right information ksi dun ako nag depende sa mga sagot nila…

  37. Sir gusto ko lang po maliwanagan. my husband was operated last January at CHONG HUA HOSPITAL in Cebu for recurrent colon cancer. I received last week my Philhealth benefit notice with the corresponding check in the amount of 12,826.19 representing my reimbursement for drugs/medicines/x-ray/laboratories. I was dismayed with what I received considering that I paid 40,000 for the PF of the surgeon, 10,000 for the attending physician and 20,000 for the anesthesiologist. It is stated in the notice that a total of 13,104 was paid by philhealth to the doctors while no amount was reimbursed to mefor the PF. I must tell you that I submitted the ORs for the PFs to the hospital clerk and that we are residing here in Leyte. It would be quite costly for me to go to Cebu to inquire about this as was advised by Philhealth Tacloban. I do hope that you could extend me your much needed help.Thank you and more power. .

    1. Hi margie, that’s really frustrating and sad. The hospital might not have submitted all the ORs or the hospital might have a certain policy on PF refunds. So the only option is to ask for refund for the 13,104 directly from the hospital. Yes, travel is expensive, so it’s best to communicate first with the hospital before going there so that the check or cash is ready before you go there. ChongHua’s phone is (32)-255-8000 or email info@chonghua.com.ph best regards

  38. hi gud morning,ako po si kannie rose and2 po aq ngyn s kuwait bilang isang ofw. ngiwan po aq b4 po aq umalis ng authorization letter pra po s pagcaclaim ng reimbursement q po s philhealth s kaptid ko po eto po ung bill ng new born baby ko n nrefund po.ns abroad po kmi ng aswa ko kya po s kapatid q pinangalan ung letter.ndi p po kc aq nkpgchange status pro ung hospital q po surname n ng aswa ko nilagay ano po kya pwede naming gwin pra po mkuha nla ung pera at maincash po nla s bangko?pls answer po..thank u

    1. Hi kannie, if you paid the hospital, then your benefit payment notice will be delivered by registered mail to your home address. Your sister can bring this BPN together with your authorization letter and her ID to the hospital and ask for refund. If the newborn benefit check is in your name, your sister can encash it only if she can show a SPA from you, pero expensive ang SPA from abroad. Merong mga nagpapalit ng checks with fee — yong mga merong connection sa banks; magtanung-tanong na lang.
      Kung meron kang bank account, puedeng ideposit ang check. If there’s discrepancy in surname, your sister can show your marriage certificate.

  39. Hi po, ask ko lang po kung mag kano yung pinaka maximum na pwedeng madeduct samin kung ang bill nmin sa hospital ay aabot ng 200k? Ang case istroke yung patient due to heart tumor? Kasama ba sya sa 22 list na ma fixed coverage rate? Kung hndi pwede bang malaman kung ilang percent po yung pwedeng madeduct smin? Actually d pa kc member ng philhealth yung patient pero may healthcard sya, pero sbi smin ng healthcard. Kelngn daw nmin byaran yung idededuct ng philhealth dun sa hospital bills nmin. Kya gusto ko sna mlaman kung ilang percent ba ang nadededuct ng philhealth pra sa ganitong case. Thank you so much. I’m hoping for your reply. Godbless

    1. Hi mark, under Case Rate, ang CVA1 coverage is 28k; CVA2 is 38k. Sorry I can’t determine which is your patient’s case. I’m also not sure if your patient’s case falls under CVA as described by Philhealth.

  40. Hi,

    May son got amoebiasis and confined for 1 day and our hospital bill was 4,500(2000 for doctor’s fee and 2500 for hospital). The amoebiasis is now under Acute gastroenteritis (AGE) – 6,000 based on your website. How much we can have in the refund? They said that we can have the cheque by July(I filed the refund last May 3).

    Thanks.

  41. Hi,

    May son got amoebiasis and confined for 1 day and our hospital bill was 4,500(2000 for doctor’s fee and 2500 for hospital). The amoebiasis is now under Acute gastroenteritis (AGE) – 6,000 based on your website. How much we can have in the refund? They said that we can have the cheque by July(I filed the refund last May 3).

    Thanks.

    1. Hi, ask ko lang po nanganak po ako nung May 7, 2013 sa isang non accredited lying in. Pwede ko po ba mareimburse yung nagastos ko sa panganganak ko sa philhealth ?

  42. hi good afternoon, i just want to ask with regards to philhealth refund. My mother was admitted at East Ave. Medical City, Quezon City, NCR then I already have all the documents needed that should be submitted on the philhealth branch, Quezon Ave. but it would take a couple of months to wait for the refund and we’re going to province this first week of july, is it ok if i will bring all the documents and pass it on philhealth branch dumaguete?
    Thank you!

    1. Hi Angelica, I think puede basta you’re within the 60-day filing deadline. One option is to submit your claim in QC; just make sure you write your permanent address in your claim forms. They’ll send the benefit payment notice and/or benefit check to the address written on the claim forms. You can call 441-7442

  43. Hi, ako po si aileen ruiz may tanong lang po ako tungkol sa claims ko sa philhealth, ako po ay naconfine sa diosdado macapagal hospital dahil sa aking operasyon na Cholecystectomy. naconfine po ako for two days at nde na po pinabayaran sa akin ang hospital bill na 6137 pesos. pero ang doctors fee na 30000 pesos ay aking binayaran ng cash. dinala ko ang aking mga original receipt dito sa dubai dahil kailangan ko sa aking company na pinapasukan dito. Ngayon po meron ng binigay sa mother ko na BPN letter. Nakasaad dun kung magkano ang dpat kong marefund, ipinasa na po ng mother ko sa hospital ang original receipt ng binayaran ko bakit ang sabi daw sa hospital wala na daw akong marerefund? bakit ganon? ano pa at nagbabayad ako ng contribution ko sa philhealth hinde ko rin naman pala magagamit? please advice po kung ano ang dapat naming gawin? sa pagkakaalam ko po ang cheque na inissue ng philhealth ay nasa hospital na,, bakit ayaw nila irefund ang dapat kong makuha? Please help me.Thank you!

    1. Hi Aileen, is it on the BPN that Philhealth paid the hospital 31k? The coverage for cholecystomy is 31k (18,600 for hospital and 12,400 for PF). You can refund 12,400 pesos from the doctor. Yong sa hospital, wala nang marefund, kasi sabi mo wala ka nang binayaran doon.

  44. Hi, ako po si aileen ruiz may tanong lang po ako tungkol sa claims ko sa philhealth, ako po ay naconfine sa diosdado macapagal hospital dahil sa aking operasyon na Cholecystectomy. naconfine po ako for three days (april 14-16, 2013) at nde na po pinabayaran sa akin ang hospital bill na 6137 pesos. pero ang doctors fee na 30000 pesos ay aking binayaran ng cash. dinala ko ang aking mga original receipt dito sa dubai dahil kailangan ko sa aking company na pinapasukan dito, ngayon daw ay kailangan ang original receipt para sa pag claim ang naibigay ko lang ay ang doctors fee receipt at ang medicine receipt ko ay copy lang. Ngayon po meron ng binigay sa mother ko na BPN letter. Nakasaad dun kung magkano ang dpat kong marefund, ipinasa na po ng mother ko sa hospital ang original receipt ng binayaran ko bakit ang sabi daw sa hospital wala na daw akong marerefund? bakit ganon? ano pa at nagbabayad ako ng contribution ko sa philhealth hinde ko rin naman pala magagamit? please advice po kung ano ang dapat naming gawin? sa pagkakaalam ko po ang cheque na inissue ng philhealth ay nasa hospital na,, bakit ayaw nila irefund ang dapat kong makuha? Please help me.Thank you!

  45. Hi,
    My husband undergoes colostomy operation.. Is it belong to case rate? if yes, magkano po kaya ang ishoulder ng philhealth?

  46. hello po.hindi po ako member ng philhealth.,,kaya wala po tlaga akong knowledge about it..ask ko lng po,kasi ooperahan po kasi ang kapatid pro may philhealth ho sya..kaso nga lang hindi kasali sa case rate..ano ho ang mangyayari pag ganitong situation..

    PS:pagnagbayad na ho ba tayo ng bill,automatic bawas na ho ba doun ang sa philhealth or later pa ba e rerefund sa atin.thank you.

  47. question nakalipas na ang 60 days pwede q pa rin bang ifile ang c2?ung c1 q naipasa q sa hospital automatic deduction ba sa bill q un?

    1. Hi jinky, your claim filing will not be accepted if the 60-day deadline has passed. Nasa bill kung nadeduct ang Philhealth benefit mo. If you submitted your C1 plus your MDR and premium receipt to the hospital, they should have deducted your benefit from the bill.

  48. hi aask ko lang po.nanganak po asawa ko cesarian po siya sa public hospital,bali po usapan po namin 18k po tapos case rate po ng philhealth 19k at usapan po namin wala na kmi babayaran tapos ng lalabas n po kmi pinabayad nya kmi 18k para sa pf at 1300 sa pedia daw po..bali nag bayad kmi 19300,.tapos nag hingi kmi resibo para ipafile sa philhealth d nila kmi bnigyan kc cla na daw po mag susubmit sa philhealth,.Ngaun po may dumating na BPN notice samin,sabi sa hospital wala na daw po kmi maclaim na benefits?ASk for help!
    thanks poh!

    1. Hi Germie, hindi kaya ang sinabi ay 18k ang babayaran nio sa doctor at wala na kayong babayaran sa hospital? Dapat naman sana ay clear ang pagka-explain ng OB. Kasi ganon nga ang nangyari. Sa 19k na coverage, 11400 ay para sa hospital at 7600 ay para sa doctors. 7600 ang puede niong marefund sa OB. Except lang kung sa unang usapan ay 18k plus Philhealth ang bayad sa kanya, meaning yong 7600 ay dagdag pa sa 18k na payment nio sa kanya.

  49. good day,ask k lng po how much po ang rate ng philhealth pag hepatitis A at neprolithiasis po ang case tnx

  50. Hi im alex. I need to undergo PDA surgery. May I know po kung magkano po philhealth coverage? Thanks a lot…

    1. Hi Alexander, sorry PDA is not under Case Rate, so there’s no fixed rate, which is good news para mas malaki ang coverage mo. Merong coverage for meds, OR, lab, PF, room, pero merong maximum amount, depending on illness severity, hospital level, and doctor’s specialization. Ask your doctor the total cost and the probable Philhealth deduction.

  51. ask ko lang po kung paano po ba makukuha yung refund ko. Nanganak po ako last april thru CS. Ang binayaran ko lang po sa hospital ay yung PROFESSIONAL fees at yung mga gamot na binili namin. Tapos bumalik po ako sa hospital to pass all the OR. Then tumawag ako sa philhealth hotline, sabi nila meron na raw pong BENEFIT PAYMENT NOTIFICATION. Ano po bang ibig sabihin nito? Makukuha ko na po ba kagad yung refund ko? Saan at paano? Saka ano po ba ang basehan ng computation ng refund sa PHILHEALTH? Hoping for your great response. Thanks.

    1. Hi glaiza, the notice is sent to you by registered mail. Ito ang dadalhin mo sa hospital, plus the ORs, para maka-refund ka. Dapat ang irefund ng hospital ay yong cost ng gamot na binili mo sa labas (up to 11,400) at yong PF na binayaran mo (up to 7,600). Usually hindi nakukuha agad ang refund, pababalikin ka nila.

  52. good day, my husband has a renal stone, the doctor suggest he (my husband) undergo shock wave treatment b’coz its quite big na daw, how much would the philhealth pay for this procedure? Thank you.

    1. Hi jassy, sori I can’t give the estimate because that procedure is not under the Case Rate list. Ask your doctor the estimated total cost after Philhealth deduction. Yong mga merong experience with eswl, may estimate na yan sila.

  53. Hai po ask ko lng po sana ,mangangank po ako next month cs po asawa ko lng po active member sa philhealth mga mgkano po kya ggastosin namen?sa ospital ng muntinlupa po ako manganganak,,ano dn po requirements sa pag avail sa philhealth?salamat po at sana mtulungan po kme.

    1. Hi michelle, 19k ang coverage for CS (11400 for hospital at 7600 for PF). I’m not sure about OsMun, pero ang alam ko kapag government hospital, pinapabili nila ang mga meds at supplies sa labas — pag ganito, ask for ORs with your complete name. Depende rin sa doctor ang PF; so kausapin mo ang doctor mo kung enough na ba ang Philhealth o magkano pa ang babayaran after Philhealth deduction. Requirements: updated MDR, premium receipts or certificate of premium payments from employer, claim form 1 for you, claim form 1 for baby, your ID

  54. I was advised my doctor that I need to go to a knee reconstruction surgery.. 150000 is the initial costing.How much will Philhealth cover? It is my first time to use philhealth.

    1. Hi Vimarie, that kind of surgery is not under Case Rate, so there’s no fixed coverage, and this is sometimes better because your coverage will be higher. Your coverage for meds, OR, lab, PF, room have maximum limits depending on illness, doctor and hospital category. Ask your doctor — he/she should be able to tell you an estimate Philhealth coverage.

  55. ask ko lang po naopera ang anak ko last june7 2013, nadeduct naman sa bill namin yung philhealth pero hindi 24 thousand. na clear na kami para makalabas sa ospital. tapos ngayong araw na to tumawag sila kasi hinahanap daw yung xray ng anak ko kailangan daw para don sa philhealth. wala naman binigay na result ng mga laboratory at xray samin bago umuwi. hindi daw naclaim yung philhealth . magbabayad daw kami ng 10500 . after 2 months sila tumawag and sila naman ang may alam ng mga requirements aa philhealth bago magbayad ang isang pasyente and na clear na kami sa payments. so, sila ang may negligence don. di na kami dapat magbayad kung di nila naayos yung philhealth?

  56. I was confined at PGH for delivering twin babies under c-section. I paid lessthan 4k for the meds tapos the ward and the docs are free. Makakareimburse b ako still sa philhealrh? Ng 19k? Even wala ako binayaran n hospital bill?

    1. Hi ladyshaon, sorry you cannot refund the 19k because you did not spend it, meaning you don’t have a receipt to show. You can refund around-4k if the hospital/doctor will accomplish all the required documents and file for you.

  57. I was confined at pgh for delivering twins under c-section. I did not pay for anything except for the meds n lessthan 5-6k. Will philhealth still reimburse the 19k? Ty

    1. nagpapacheck up po aq sa FMAB PGH pero sinabi ko po sa OB ko na sa charity lang po ako manganganak..sabi nya po sakin 15k daw ang cachout kapag CS-SECTION?..bakit po kaya ganun?..sa inyo po 5-6k lang nagastos nyo?ask lang po..reply po pls..

      1. Hi Joy Anne, hindi ako sure sa policy ng PGH, pero ang intindi ko, para lower cost, kung charity ang delivery, dapat sa charity ka rin nagpapacheckup. Kung total cost na yong 15k na sinabi niya, okay na yon palagay ko, compared sa mga comments dito na 26k to 27k ang siningil at sa government hospital din kaya lang private room.

  58. nanganak po ako last june 28 thru cs sa ospital ng maynila.magkano po marerefund ko kung 6thou lang po binawas nila kasama new born.ska 600 po singil nila kapag ala philhealth.pde po ba marefund yun?ska bumili din ko gamot sa labas worth 4thou.pde po b irefund yung mga ultrasound ko at lab expenses?

    1. Hi rose, wait for the benefit payment notice from Philhealth, then bring receipts of meds you bought to the hospital for refund. Your coverage is 11,400 for hospital costs and 7,600 for PF

  59. nanganak po ako thru cs sa ospital ng maynila.may marerefund pa po ba kami?6 thou lang daw ang limit ng philhelth at wala na daw po kami marerefund.may mga binili kaming gamot sa labas.

    1. Hi lyndon, wala sa Case Rate list ang tonsillectomy, so I can’t give the estimate. Merong maximum benefit amounts for meds, PF, OR, lab, room, depende sa hospital/illness/doctor category.

  60. Magandang Gabi,

    Puede po bang i-cover ng Philhealth ung procedures para kapatid ko. Kailangan alisin ung bato sa kidney gamit ang shockwave as per advise ng kanyang doktor. Miyembro po sya since 1995 isa po syang OFW seafarer kaya lang mag isang tao na po syang di nakakasay.

    Salamat po.

  61. Hello po …my mother is having highblood pressure , she’s a dependent of my fathers philhealth ..she’s admitted at the private hospital.ang tanong ko po, ilang araw po ba Dapat magpa confine? para wala ng excess na mabayaran.tnx po

    1. Hi Lynn, depende sa diagnosis, doctor at sa hospital. Kahit 1 day lang kung expensive hospital, at hindi kasya ang Case Rate coverage for hypertension (kung hypertension ang diagnosis), meron pa ring kayong babayaran. Kung hindi under Case Rate ang diagnosis, sure na merong babayaran.

  62. hello po naconfine anak ko sa hospital ng 3 days pneumonia ang findings tinanong namin kung magkano doktors fee 1500 daw kda araw nag pabayad ng cash yung sa doktor binayaran namin sya ng 4500 cash for 3 days ng lumabas ang bill namin sa hospital kumaltas pa po sya ng another 4500 sa philhealth bale lahat po 9000 ang napunta sa doktor nang tanunngin namin ung casher ganun daw po talaga pag may philhealth tama po ba iyon?

    1. Hi ernest, hindi tama yon. 1500 ang sabi niyang PF niya, eh nabayaran nio na yon in cash. Sabihin nio sa cashier na nabayaran nio na yong doctor ng 4500. Sana kung 3k ang PF niya, dapat yon ang sinabi na niya noong nagtanong kayo. Tanungin nio na lang kung para saan yong additional 4500; yon ba ang charge niya sa pag-sign niya sa Philhealth forms? Sana hindi namang 4500 ang kinuha. Ang mahal naman ng signature niya.

  63. hi po.nagpa radioactive iodine therapy po ako last july24 2013 s chinese gen.my hmo po.bnayaran nila un bill ko n 5536 then kelangan ko dw byaran s knila un 2200 n sagot dw ng philhealth.pina debit memo ko nlng s sahod ko so kinaltasan ako ng company ko taz ibnyad s hmo.nklgay s debit memo ko n ndi dw ako ngfile ng philhealth so need ko byran un 2200.under radiotherapy nilgay nun hmo s memo ko.panu ko kya mrreimburse un s philhealth?ang nsa akin lng eh un charge slip n galing s chnese gen nuclear med n my amount n 5536.taz nkpangalan s company nmin un debit memo n knaltas skin.pwde bng un nlng pkita ko s philhealth?ttnggapin n kya nila un pra mkpgpreimburse ako?kz ngpa file sna ako nun july 24 dn mismo ng philhealth.sbi s accounting ng chinese gen kulang dw un pinasa ko.mdr+cf1+charge slip lng meron ako nun..need kya nila un breakdown ng part ng philhealth?tanx po..

    1. Hi jj, ibig sabihin hindi sila nag-file noon? If yes, at hindi ka pa nag-file, late na. Within 60 days after treatment dapat ang filing.

  64. hello philhealth yung nephew ko nagkpneumonia at nconfine cya sabi pag my philhealth 15 k yung mababawas kaso hnd nmin naisubmit yung requirements sa 3 days n bngy ng hospital sabi nila hnd daw pd n personal claim kasi pneumonia yung case so bnyaran nmin ng buo 17k in two days.hnd po kasi nklgay n dependent yung nephew ko sa parents nya kaya gnun.ask ko alng po pd po ba ireimburse pag nhaabol at malagay n dependent n cya.thanks po!!

    1. Hi jan, within 60 days pa ba after discharge? Puede pa kayong mag-file ng claim sa Philhealth. Get hospital OR, PF OR, claim forms, statement of account/billing from hospital plus waiver from the hospital and doctor so that the check would be in the parents’ name. Update MDR at Philhealth (bring birth cert, xerox and orig) and then get updated MDR.

  65. Hi po!

    Ask ko lang, nadischarge na baby ko last sept 7 for pneumonia, then meron ng nagawang deduction na 15k (10500 sa hospital, 4500 sa doctor)from philhealth, tapos ang nabayaran ko nalang was the excess sa bill which was around 4k plus doctor’s fee na 3500, may mga antibiotic akong nabili (around 5k) outside, May refund pa po ba akong matatanggap sa mga nabayaran ko??

    If meron po, ano ang mga documents na kailangan?

    Thanks and Godspeed!

    1. Hi Karen, okay ang hospital na yan sa pag-implement nila ng Philhealth. Nagdeduct sila agad. At tamang amount. Maraming nagco-comment dito, hindi maayos ang deduction, at hindi pa complete deduction, kelangang refund yong iba… yong iba, walang deduction kesyo ganito ganire. Anong hospital yan? para mapalakpakan. Sorry di mo na marefund ang expenses for antibiotics kasi na-consume mo na yong 15k allotted for your baby’s pneumonia case (I am assuming pnemonia 1 yan kasi 15k ang total deduction mo). Pero ask others pa rin.

  66. I just want to ask if how much is the total Philhealth coverage for a member baby that’s in a Type “B” Case (Premature & Sypsis)?

  67. Good evning mam ang misis ko naka schedule sa operasyon na gallbladder( bato sa apdo) sa gov. Hospital sa cebu. Ang charge ng oprasyon p30,000. Magkano ang payment ng philhealth at sa akin. Para may idea ako sa pahahanap ng pangdagdag. Thnxs I’m Evencio Tradio of cebu

    1. Hi Evencio, kung tatanggalin na rin ang gallbladder (procedure is cholecystectomy), ang coverage is 31k (18600 for hospital and 12400 for PF). Ask your doctor too.

  68. gud day po.. i have a multiple gallbladder stone 31k ang covered.. kung ipafile ko lahat ng receipt during amy operation accepted ba yun or madededuct po ba yun?

    1. Hi desirre, it would depend on your doctor, the hospital and your documents. You mentioned receipts, why, is this a government hospital? And that you bought or will buy supplies outside the hospital? Always keep copies of docs and ORs for your own filing or claim later on. 31k is further allocated as 18,600 for hospital costs and 12,400 for PF.

      1. sa chinese gen po kso charity…nung nanganak po kc ako dun lahat ng receipts ng gamot ko even receipts ng lab. kht sknla gnwa eh hindi ko nareinburse… ano nga pom pla ang pf?

        1. Hi desirre, pf is professional fee — yong payment sa doctor. Kung charity, libre na ang pf, kaya pinabili ka na lang ng gamot. Pag charity, hindi na ginagamit ang Philhealth. Baka mas mahal pa ang gastos mo kung gamitin ang Philhealth tapos 20k halimbawa ang pf at 2k lang ang mababawas; kalimitan hindi pa binabawas. Sa hospital cost including meds and supplies, 3k lang ang nababawas.

  69. Hello Mam,

    Just want to know if my mother could avail philhealth discount (out patient), she will having a ct scan tomorrow. The ct scan amounting to 12,000 and she is a dependent member under my fathers philhealth both are senior citizen. Can she avail both benefits senior citizen and philhelath discount? Please advise. Thank you and god Bless.

    Jojo

    1. Hi josephine, sori pero hindi siguro kasi ang CT scan is a diagnostic procedure. Covered lang ang portion nito kapag naperform during confinement at merong din treatment na naperform. Pero tanungin nio pa rin yong hospital.

  70. good evening po, ask ko lang po if thyroid lobectomy is classified po sya under thyroidectomy, 31k pa rn po ba ang ibbawas ng philheath?

    1. Hi anne, it would be best if you ask your doctor. I researched and thyroidectomy usually refers to removal of the whole thyroid gland while thyroid lobectomy is removal of part of the thyroid gland.

  71. Good evening po, ask ko lang po if thyroid lobectomy is classified pa rn po sya undr thyroidctomy, 31k pa rn po ba ibbwas ng philheath?

  72. Hi good morning,I’m a dependent of my husband and I will undergo a laparoscopic cholecystectomy,I ask a package for it of 60-70k at PGH,ask ko lang magkano kaya mamba was sa philhealth ng husband ko..thank you

    1. Hi Mich, 31k ang coverage (18600 for hospital and 12400 for PF). Ask your doctor your estimate total cost if you use your Philhealth because sometimes deductions are not clear cut, especially in cases where the patient is asked to pay the PF directly to the doctor.

  73. Ang mother ko po ay na laser na sa both eyes nya catarata…after 3 years bumabalik ang kanyang catarata. ask ko lang pwede pa bang gamitin ang philhealth ko as her benefits?. dati kasi philhealth card ko ang ginamit nya. thanks sa sagot

    1. Hi dan, if your mother is 60 years old or older, you can use your Philhealth for her. Find a Philhealth-accredited opthalmologist — cataract removal needs pre-approval from Philhealth.

  74. Hello po! Ask lng po sana kung cover ba sa philhelath ang heart surgery?? My brother will have surgery soon sa cebu. Please response. Thank you!

  75. Hi Good Morning,

    My son was confined for two days last August 29 due to amoebiasis in a hospital. May i ask how much should be the philhealth coverage for the said case. As per billing statement, we still paid P1,000+ after deduction of philhealth, total was P4000+ but we noticed the pf was not indicated in the billing, we paid separate P2000 for the doctor, she gave OR for it.Then, last October 7, we verified from the Billing regarding the pf that was not indicated in the SOA, the hospital gave us another statement of account in handwritten form, breakdown for pf was P4300, less P1800 philhealth,
    and the cash payment we made for P2000 (it shows there’s P500 discount by the doctor. Maam, based from the computation they made the doctor will be paid by philhealth by P1800 aside from the P2000 cash we gave. Mam, did the hospital and the doctor over charged us. How do we know if we have a refund? Please enlighten us. Thank you.

    Clarissa

    1. Hi Clarissa, amoebiasis is not under Case Rate, so the coverage is not fixed, so I can’t say the exact coverage. Wait for the benefit payment notice from Philhealth, and check how much Philhealth paid to the hospital. If Philhealth paid more than what was deducted from your bill as Philhealth coverage, refund the discrepancy from the hospital. Keep copies of your bills and receipts.

      1. Thanks for the feedback, we’ll just wait for the bpn from Philhealth. How long does it usually sent by Philhealth?

        Thanks,
        Clarissa

  76. mam sir ask ko lang po kung under what category po ang bhroncitis . magkano po yung rate na pwede naming ma avail tnx po…

      1. i was admitted for 2 days last week due to acute brochitis with dehydration. secondary finding was acute laryngitis.. though all med lab results indicate normal findings. the throat was so infected i guess including larynx coz nawalan ako ng voice for almost 2 days and 1 week na minamalat pa rin ako..had fever for 3 nights and not able to eat or drink water because masakit talaga my throat prior to hospitalization. day 1 sa hospital dextrose and antibiotic by iv.. day 2 dextrose and addtl antibiotic by iv plus more medicines… been coughing so bad even when i was in hospital.. doctor recommend sputum test due to yellow to green plegm i guess… philhealth sa hosp said hindi daw covered ang acute bronchitis for hospital case… i was and still am so upset… not only for me but for the children na common ang bronchitis.. can you pls enlighten me.. thank you

        1. Hi mammu, I don’t know if the Philhealth personnel in the hospital misinterpreted the rules (kasi new pa ang mga circulars), or talagang ganon na merong mga conditions that are covered only if they’re treated at a primary hospital. Sa list kasi for primary hospitals, merong acute bronchitis (2800 ang coverage) pero sa general list, wala ang acute bronchitis. Yong mga more serious cases of bronchitis-related ang andon like COPD, etc.

    1. Hi ag, kung sa charity ka, gamot lang ang bibilhin mo, libre ang doktor at hospital. Pero kung gagamit ka ng Philhealth, bibili ka pa rin ng gamot at babayaran mo ang doktor, then file for refund. Minsan hindi na nagrerefund ang doctor; depende sa hospital. Sorry I don’t know the cost estimate. Under the Philhealth case rate scheme, hysterectomy coverage is 30k (in some government hospitals, malabo ang pag-implement nila sa case rate). Hysterectomy is removal of the ovaries; since tumor lang ang tatanggalin sa iyo, hindi ko alam ang coverage amount.

  77. Ask k lng n d@ c aq las aug.14,2013.ngpay aq ng pf s nurde station lng den i think indi official receipt yn pf k oc nsa small piece of paper lng 24t ang pay k,plus ngdown p aq ng 3t,@ ng mkita k bill k 1,800lng mrefund k,ble 3,800 plus lng nbwas ng philheath k,tas ble wla nkaltas s pf k,,,sbi kc ng dr. K don mgpay..bt nkita k s philhealth dpat 11t ang pay skin ng philheath,,kc nsa case base rate aq..j.reyes hosp lng yn,nsa private rum aq bt 1day lng..wat shud i do..den nid k din mgpsched.for hysterectomy ds month,can i still use my philheath im paid to my contribution until dis dec…tnx,nid ur response..

    1. Hi lryn, antayin mo na lang ang benefit payment notice mo and then ask for refund from the hospital later on. Keep your receipts and copies. Maraming ganyang kaso na ikinukuwento dito na kapag sa public hospital, yong PF hindi thru cashier, diretso sa doctor, at hindi tuloy ma-deduct from Philhealth. Different naman ang hysterectormy at D&C, so puede palagay ko within 90 days. Pero tanungin mo pa rin yong surgeon mo para sure.

  78. Ask ko Lang po kung ang check up at medical laboratory can be reimbursed in my case. I have a goiter, hypothyroidism.I paid my philhealth this year.

    1. Hi remy, sad to say, kapag outpatient ang diagnostic procedures, hindi covered. Siguro later on pag mag-iba ang policy. Ask others too

  79. Hi there,I am a Philhealth Member This is what was explained to me by a friend….Here is what I understand with the system, please correct me if I am wrong…

    Philhealth was created in order to ease the burden of paying hospital bills and Professional Fees of Doctors, and not to add additional income to the Doctors and Hospitals, and that the fix rate (package rate)was created in order to make Philhealth computation easier and that the billing department wont make mistakes in the computation so that the member would get the whole benefit Right?

    I cant find any link on how Philhealth makes the computation so here is my own understanding on how it goes..Please correct me if I am wrong…

    If Hospital Bill Total is 20,000.00 and out of this 20,000.00 the 5,000.00 is for the PF..Am I correct in saying that Member should be deducted 15,000.00 (covered rate for Pneumonia I)30% PF and 70% Hospital fees? So 30% of 15,000.00 is 4,500.00 we deduct that from the 5,000.00 PF right? and deduct 10,500.00 from the the remaining 15,000.00..the amount that should be paid by the member should be 500.00PF and 4,500.00Hospital Fees.

    If I am right, how come most hospitals cannot do math properly? And what is the sanction for the hospitals who do not give what is properly due to the Philhealth members? There are many who thinks that they should have a percentage of the members benefits and that they do not deduct the full amount from the members bill. Is this how it should really be? That the hospital and doctor should get a certain percent from the member benefit? What if? Total bill is 15,000.00 including PF I understand that the member should not pay a single centavo since the amount is still covered by Philhealth (Pneumonia I)right? But most hospitals would still bill members because of their lame reason na ” e di wala ng babayaran ang member?” But that is what Philhealth is for right?

    Sorry had an experience with a hospital, the billing officer said that balance that they did not deduct from the member would be used on the confinement..What the ??? I have the BPN on hand and whole amount was given to the hospital..

    I want to understand what they were trying to tell me? But that is not how i think it really works..

    Philhealth is for the members and not for additional income of the Hospital or the Doctor…

    Thank you.

    Frustrated Mom

    1. Hi Dolly, you’re right with your math. With your example, the member should have paid only 5k. And you’re right that some doctors and hospitals believe that they should be paid for their time and effort in filling up and filing Philhealth forms. Many doctors also claim the Philhealth coverage for PF in addition to the PF paid to them directly by patients. You write well, so I think it would be good if you email Philhealth about this and make comments at facebook.com/Philhealth, and more members should write Philhealth about their complaints, even if at first, there seems to be no effect on them.

      1. Thank you Nors, what is it that we can do to put a stop on this malpractice? It is becoming a norm for these people and those Philhealth members who asks to have a re-computation or a refund are made to feel that they are the one who are “mukhang pera” but I believe every centavo should be given to the Philhealth members. All people from all walks of life should be given fair share on what is supposed to be theirs.

  80. Naka admit po bby ko ngayon s hospital due to neonatal sepsis and pneumonia magkano po kaya m less ng philhealth? thanks

    1. Hi maricel, only one of those 2 diagnosis will be covered — the primary illness. Pneumonia 1 coverage is 15k; pneumonia 2 is 32k — will depend on lab results and your doctor’s final diagnosis. Sepsis is covered under the fee-for-service scheme.

    1. Hi Mae, is your mama confined? Yes, she can be covered if she’s confined and there’s diagnosis and treatment. Or do you mean dialysis as outpatient? If yes, she can be covered. Find a Philhealth-accredited dialysis center. Basahin mo yong sagot ko kay Cindy dito: Hemodialysis coverage

  81. Good PM I am OFW my mom was my dependent in my Philhealth last April 30′ 2013 – May 15, 2013 she was admitted in a Govt Hosp in Neg. Occ. when she was D/C still we paid almost 3k in w/c she was covered in package rate of 28k (CVA1) our bill was only 19k (if am not wrong) then we are buying her medecines from outside b/c it is not available in that hosp..They are telling that not all injectable (IV meds) are covered by Philhealth then I’ve seen also that instead they have to give back our PF they put the name of the Chief of Hosp (she is not our treating Physician) in w/c we got a private Dr and we payed separately (almost 8k) after how many days again my mom was admitted in a semi private Hosp in Neg Occ we did not pay any certain amount upon her D/C.. Our refund was given 2700php(w/out notice fr Philhealth) in w/c she was admitted for 4 days only but in that Govt hosp until now they did not give the refund b/c no notice from philhealth…can you give me a feedback if really IV meds are only selected even my mom case was on package rate? and it is right that instead they will give back our PF they put the name of the COH (for what reason?)Ever since i never receive any notice from philhealth even i will check in post office no notice for me.
    Thank you and more power
    God bless

    1. Hi my, do you mean the govt hospital returned the almost 8k you paid for PF? The 28k coverage is allotted as 19,600 for hospital and 8400 for PF. If the 19,600 has already been used for hospital costs, then there’s no more allotment for the meds you bought outside the hospital. About the use of the name of the COH on the receipt, I can’t know the reason behind — maybe the private doctor is not Philhealth accredited. Yes, Philhealth refunds only meds included in their meds list; but I think it’s not the real reason because CVA1 is under Case Rate. God bless too.

  82. Good PM
    I am OFW my mom was my dependent in my Philhealth she was admitted last May 2013 2x ( April 30 – May 15 , 2013)CVA1-28k at a Govt Hosp. next admission was June 4-June 8, 2013-(Semi Private Hosp)(Pneumonia1 – 15k) our refund in semi govt was given already and i think it is correct and no BPN…In that govt hosp they are looking for BPN and as what i experienced to this hosp we paid almost 3k (hosp) in w/c my mom was on package rate and our bill did reach 28k.. They also told that some IV meds are not covered by Philhealth in w/c for my understanding if a certain person under package rate whatever medicines u purchase outside as long that u did not consume ur package rate will be refunded.. and the worst was PF was name to the COH not to our private doctor (in w/c we pay separately 8k)is this right?
    If so u can give me a proper guideline about the refund and purchasing of medicines outside the hosp and the PF of the doctor
    can i make or file a complain against them esp who is in charge of reimbursement of Philhealth and why they will make this things so complicated. Last year my mom was admitted in same govt hosp and we did not receive any BPN i went to Philhealth office and get the print out for package rate then that’s the time they give our refund but unluckily only 1700 because of he said reason i mention above in which my mom was admitted more than 10 days so now am wondering why my mom got a refund in semi private hosp (4days admission)higher than the govt hosp w/c we are buying outside medicines
    Thank you and hoping for your reply
    More power and God bless

  83. hi po…im a philhealth member at ang asawa ko po.pasensya na po madami akong tanong,ung asawa ko po nag pa endoscopy sya last dec 14 2012,pinauwi din po kami nun after nun,,,20,510.79 po dapat babayaran namin naging 12,323.27 n lng po,,tama po ba ung inawas samin?Gumamit po kc kami ng philhealth that time,kng hindi po tama pd p b po namin maclaim un?Ako naman po sa appendix last june 25,,naadmit po aq nung june 23 2012,d po ako nakabayad ng philhealth nun nung may,,d po ba tlga pd gamitin un kahit 1 month lng ung d bayad?Naka 50,421.81 kmi nun d pa kasama gamot sa labas,tpos naoperahan ako kahit ung appendix ko normal naman,,and last question po covered po b ng philhealth ang MRI? at magkanu po un? and last na po,pd po ba pag nanganak aq o my gumamit samin ng philhealth pd po bang bayaran ng buo muna sa ospital lahat ng bill,tapos pag kalabas n lng iclaim sa philhealth ung iaawas sa bill ko kc po my nkapagsabi na hindi daw po tama yung bawas ng mga ospital,,,pakisagot po plssss maraming salamat po

    1. Hi diana, I’m puzzled na na-apply ang Philhealth sa endoscopy nio in Dec 2012 eh diagnostic procedure yon, except lang kung na-confine siya, or kung merong diagnosis na illness at treatment. About your appendectomy: individual payor ka at kulang ka ng 1 month sa required payment of 9 of 12 months before June? Yes, kahit 1 month lang ang kulang. Pero this Oct, in-announce na puede na ang 3-month payment sa informal sector. Are you both employed? That’s why both of you are paying? If you’re individual payors, one can be a dependent of the other, so only one will be paying.
      About your last question, yes, you can do that. But make sure you get all the docs from the hospital including waiver from the hospital and doctor, hospital bill or statement of account and payment receipts and the claim forms signed by the doctor and hospital.

  84. hi.thanks for your reply.ask ko lang po kung matagal po ba iclaim yun?At gaano po katagal?Tanung ko lang po dn ulit ung sa MRI SCAN,sakop po ba ng philhealth yun?Salamat po

    1. Hi diana, diagnostic procedure din ang MRI scan, at hindi ito covered as outpatient. Ma-cover lang ang part of it kung confined ang member, kung merong diagnosis at kung merong treatment na nangyari.

  85. Good day po!tanong ko lang po para maka sure nag apply po yung asawa ko philhealth kahapon po Oct.30,2013 hindi po kame kasal hiwalay po sya sa asawa nya,ngayon ang ginamit nya po na apelyido para sa membership yung apelyido sa pagkadalaga,ang problema baka hanapan po sya ng another valid i.d pag nag present po ng philhealth i.d para sa discount kasama resibo at MDR,bale wala po kame maipresent na another i.d kung sakaling hanapan sya,meron po sya i.d pero sa asawa nya yung apelyido.hindi kaya po magkaroon ng problema?anyway,binayaran namin yung premium na 1,800 pesos kasi sabi nung nag process nung application ng misis ko,pwede pa macovered basta bayaran ung premium,kasi ngayong darating na november 15 po manganganak misis ko by CS,tanong ko lang po kung sure po na macovered ng 19k galing sa philhealth yung babayaran namin na 45k(packagedeal ng hospital po yun)sa hospital?maraming salamat po.

    1. Hi al, ang deduction depende rin sa hospital at doctor. Ask your ob kung magkano ang cost kapag merong Philhealth. Yong 19k ay allocated as 11400 for hospital and 7600 for doctors; minsan yong 7600 hindi dinededuct. Sa registration ninyo, ang category ba ay Informal Sector? At okay daw ba yon kahit hindi 1 year ang binayaran ninyo?

  86. Hi Nors. I was operated last Sept. of this year. They removed one of my thyroid (thyroidectomy). I took avantage of my hmo card and philhealth. I was charged a total of P51,276.58. They charged my philhealth for P11,600 only and P39,043.40 from my hmo card. Then i paid only P633.18 cash for misc..I just recently recieved the benefit payment notice from philhealth amounting to 31k. Did they over charged philhealth? Am i going to get a refund for the difference of 31k from P11,600 or will the hospital still get the full amount? Depende ba yun sa case if ngamit ang full amount o hindi sa hospital prin ppunta yung 31k? Thank you..God bless

    1. Hi bobby, I wonder why you were still charged with 633.18. Try asking for a refund, but if you’ll lose more than this amount by spending time and effort to go there maybe 2 or more times, then siguro pabayaan mo na lang. The balance (31k – 11.6k) will go to the hospital and the doctor. I also wonder why the HMO did not question the deduction… because if the hospital deducted 31k, then they could have paid only around 20k (bill – 31k). Or even if the hospital deducted just the hospital share — 18600 for hospital and for 12400 for doctor, the hmo charge could still have been lower. God bless too.

  87. Hi, Good morning! I’d like to seek some advise po sana regarding the case of my father. He was diagnosed of Acute Gastroenteritis (AGE) in a hospital in the province, however Doctor’s advise/recommendation is to undergo Endoscopy in another hospital because they don’t have the facilities for it. Upon discharged, we availed the philhealth benefit, my question po is, can we still avail of the philhealth benefit once admitted in the new hospital to undergo the necessary tests (given that the diagnosis is most probably related to the original diagnosis)? Thank you po. :)

    1. Hi Vanessa, I’m surprised that endoscopy was covered as this is a diagnostic procedure. If the 2 treatments in the 2 hospitals will have different illness/treatment codes in the claim forms, then they will both be covered. You can check what the doctor who did the endoscopy wrote in the claim form. Ang rule ng Philhealth is kapag 2 or more confinements within 90 days, dapat hindi the same illness/treatment para ma-cover pareho.

  88. Hello po. My daughter underwent surgery for closure of ventricular septal defect at Phil. Heart Center last week. We know that this could have been under Case Type Z. However, since she is less than a year old and is with Down Syndrome, we were told that she is not qualified to avail under Case Type Z. In this case, may we know which Case Type will apply? How much will be shouldered by Philhealth for her medicines, surgery, etc? Or will this be under a fixed case rate payment?

    Thank you very much.

  89. Hello,

    My son was hospitalized last October 14, 2013 ang final diagnosis po ay Age with Moderate signs of dehydration. Total bill namin 25K – 6k lang po ang nacovered ng philhealth, at pinag bayad kami ng difference na P6K ung iba naisama sa hmo nia.

    Makakatanggap pa po ba me ng refund dun sa 6k na binayaran ko in cash? Before kc whenever my son was hospitalized, i usually receive a check after two months.

  90. want to ask if can refund ct scan done as outpatient. In case of refund what documents should i need to prepare prior to the processing of refund. Or are there certain discount, deduction as PH member for ct scan?

    1. Hi mark, sori po, I think you cannot refund because CT scan is a diagnostic procedure, it was done as outpatient, and there was no treatment. Ask Philhealth too.

  91. hi! i was diagnosed with Adenomyosis and was told to undergo Hysterectomy. my husband is a member of Philhealth. please enlighten me. how much will it cost me if it’ll be done in a category 3 hospital? i understand philhealth will pay 30k for it. but hospitals usually charge other kung anu-ano specially in privates ones.
    thank you

    1. Hi mina, you have to ask your surgeon or OB how much you will pay for hysterectomy if you use your Philhealth. 30k is allocated as 18k for hospital costs and 12k for PF. You pay the balances. Sometimes also, the 12k allocation for PF is not refunded kasi kukunin ng OB or surgeon in addition to the PF that you will pay, meaning 18k lang ang madededuct sa bill. So magtanung-tanong.

  92. gud am, ang goiter po ba cover ng philhealth?gusto ko sanang magpa opera kaso hindi ko alam kung ilan ang aming gagastusin sa operation?

    1. Hi Cath, yes, covered ang goiter operation. Magpacheckup na lang and then ask the doctor your total expense if you use your Philhealth.

  93. hi gud day na operahan po ako sa PGH last sept 10 sa liver gallbladder ask ko lang po f magkano po ang marerefund ko po sa phil health ks sa PGH po lhat po ng resibo ng bilniling gmot un po ang pinapasa sa amin,tas 3 to 4 months daw po thanks po

    1. Hi Connie, kung removal of gallbladder ang surgery mo, 31k ang coverage (18600 for hospital and 12400 for surgeon). Kung hindi nagasto lahat ang 18600 sa ospital, at meron pang natitirang amount for medicines, marerefund mo ang mga nagasto mo, depende kung magkano ang natira for medicines.

    1. Hi rackz, nabasa ko sa PIA na circumcision is not covered by Philhealth. Siguro dahil hindi siya treatment of a medical condition. Kung removal of skin daw caused by an infection, yon daw ang covered.
      Pero sa ibang write-ups parang covered ang circumcision; so magtanong ka pa rin sa iba. Sa Philhealth website kasi mismo, wala akong makita about circumcision.

    1. Hi brian, yes, covered ang chemotherapy by Philhealth. Kung ang case ay breast cancer at bagong diagnosis pa lang, magtanong sa Philhealth kung paano maka-avail ng Z benefit package.

  94. My auntie was hospitalize and undergo mass lesion surgery, one of kidney was removed and it was a cancerous I just want to check how much will the philhealth coverage. Thank You

  95. hello po. i gave birth by CS delivery last August 31 and i receive my refund notice last thursday amounting to 220 pesos. di ko man lang nabawi ung ginastos ko sa gamot. ganun po ba talaga un? and the other thing is di ko nakita dun sa bill ung pngalan ng mga doktor na binayaran ko. (OB, anesthesiologist & Pedia), ang nkalagay lang po dun ay ung hospital payment, member at chief. sino ba ung chief na un? nakakapagtaka lang po na nung nagectopic operation me 5K ung narefund ko, tapos ngayon kung kelan ang laki ng gastos ganun ka konti ang refund. posible po ba un? Thanks for the time.

  96. hello po my daughter admitted December 23.2013 and diagnose moderate pneumonia.total bill po namin is 12,317.40 the deduction for the philhealth is 10,817.40 dba po 15k dapat ang deduction nila.and balance ko na dapat bayaran ay 1,500..pede ba ma refund nila sa akin ang 1.5k?please reply [po

    1. Hi grace, kapag mas malaki ang Philhealth coverage kesa actual expense, mapupunta ang difference sa hospital. Sa 15k na coverage, 10,500 ang mapupunta sa hospital at 4500 sa PF.

  97. hi po, tanong ko lang po, naconfine po and anak ko last october 14, 2013, dengue case po. ngayon po january 17,2014 na dengue sya ulit pwede pa po ba namin magamit ulit ang philhealth benefit ngayon? thanks po.

    1. Hi emily, puede na ma-cover uli, kasi outside na ang Jan 17 sa 90-day period since Oct 14. Pero baka lang mali ang counting ko, tanungin mo muna ang hospital.

  98. Hi im Lhynne, ask ko lang po kung covered ba ng philhealth ang indometrial cyst. Kasi sabi ng obygne doc ko na kailangan ng tanggalin. If ever magkano ang covered ng philhealth? Thanks!

    1. Hi Lhynne, covered yan, kasi surgical procedure for a medical purpose, pero hindi ko makita yong endometrial cyst removal sa new Case Rate list nila. Merong removal of endometriomas, pero hindi ko alam kung ito yon, which has a 30K plus coverage. Ang ibang cyst removal sa list, 20K up. Ask your OB your estimated cost if with Philhealth.

  99. Hi, i’m about to have Dilatation and Curettage because of miscarriage. I saw on the table of surgical cases na 11,000 pesos and case rate. Included na ba dyan yung professional fee ng accredited OB/GYN doctor? It’s a private and accredited hospital din po.

  100. ask ko lang po kung ano po ang kailangang forms para sa panganganak ng CS operation sa Ospital ng Maynila? Philhealth member po ako..
    magkano po ang babayaran ko doon?
    Kami daw po ang bibili ng mga kailangan naming, pwede po ba mareinburse iyon? may form po bang kailangan sa reimbursement ng mga resibo?

    1. Hi Maria, ask for ORs for the supplies you will buy. ORs should be in your name. You will ask for refund pag meron ka nang natanggap na benefit payment notice from Philhealth. Kung private ang OB mo (kasi may Philhealth ka ,so paying patient ka), puedeng hindi kasya ang Philhealth coverage, so ask your OB. Philhealth docs: MDR, premium ORs (keep your copy), claim form 1 for your and claim form 1 for baby, valid ID.

  101. Hello po, tanong ko lang kung pwede bang macover ng PhilHealth ang pang-out patient surgery due to physical injuries?

    1. Hi Zendelyn, yes, covered, pero ask the surgeon first about Philhealth coverage kasi siya ang magfi-fill-up ng claim forms.

      1. Hi Nors,
        Unfortunately, not in University of Perpetual Help Medical Center Las Pinas. I paid evrything kahit pa pinaliwanag ko sa kanila na covered ng Philhealth ung surgery (stitching of lacerated wound sa head) na ginawa sa ER. Pinagpilitan ng nurse ng ER sa perpetual na hindi daw sagot ng Philhealth ung ibang hospital expenses. Philhealth will only cover the expenses kung na-admit ang patient. Sa case namin, hindi na-admit ung patient so we have to pay everything. According to my friend na taga-Philhealth, he said na covered daw ng Philhealth with or without admission pero ininsist ng ER nurse na hindi talaga sagot ng Philhealth. We tried to wait for the Philhealth rep para magtanong pero parang pinapaalis na kmi sa ER. That is very rude. Im sorry kung dito ko nilalabas yung sama ng loob ko sa UPHMC.
        Your website is very helpful. Sana marami pa masagot natanong about hospitalization through this site. More power.

        1. HI Joy, day surgeries are covered, but yes, it’s sad that medical personnel don’t like to fill up lots of forms for Philhealth reimbursement for certain non-confined cases. It’s also possible that the one who performed the stitching is not Philhealth-accredited. Thanks a lot for appreciating our efforts. Means a lot.

  102. Hi . I just had a misscarriage. Im still bleeding. I have fears na ano manyare sakin. And fear na ma judge ako for someyhingi did not do. Any ib gyne here who can help me? How much poang d&c sa pgh? Please help. I dnt know what to do. Ayoko malaman ng parebts ko din ang kalagayan ko ngaun.

    1. Hi ellen, covered siya. Ang hindi ko lang sure if covered siya kahit hindi ka confined for a certain condition. Dati kasi kung purely for diagnostic purpose lang, hindi covered. Ask others too.

    1. Hi Angelo, kapag Individual Payor-Informal Sector, 3 contributions within the past 6 months before confinement. The same with Employed members.

  103. hi po! ask ko lang po kung how much ang mako cover ng philhealth ng husband ko kasi naka schedule po sya for vitrectomy surgery para sa kaliwang mata nya. thanks.

    1. Hi ms. lyn, ask na lang your doctor, kasi hindi ko alam kung yong vitrectomy na gagawin sa husband mo ay kasama doon sa vitrectomy types in Philhealth’s Case Rate list. Coverage is 46,500 (25,200 for PF; 21,300 for hospital). Usually din, cash ang preference ng doctor.

  104. hi,

    yung grandfather ko is a lifetime member ng philhealth, gusto sana nyang ipaopera ung mata nya ksi may cataract. covered ba yang operation sa philhealth?ano po ba ung dapat n una naming gawin pra mapaopera ung cataract nya.

    thanks

    1. Hi shieianlouise, magpa-consult muna sa Philhealth-accredited ophthalmologist na nagpe-perform ng cataract removal, and then ask kung puede niong magamit ang Philhealth. Kelangan kasi ng permit from Philhealth bago gawin ang cataract removal. Yong ophtha ang magfi-fill-up ng request form.

  105. tanong ko lng po twice na nagamit ng dad ko ang philheath kc hes 1 of my dependent bt eversince la akong refund na matanggap? saan ko pwed efolow up to? tnx po

    1. Hi greta, nagsa-submit ka ba ng claim forms sa hospital? Dapat meron kang natatanggap na benefit payment notice from Philhealth. Then present the notice and receipts sa hospital for refund.

  106. Hi Po! Sa PGH po may Philhealth passbook na ginagamit tapos lahat dapat lng bibilihin mong gamot sa Pharmacy lang nila. Ask ko lang po kapg may binili akong gamot sa labas ng PGH within confinement ma re-reimburse pa po ba yun? sabi kasi ng PGH Philhealth personnel eh “lahat ng gamot na bibilihin outside PGH regardless kung within confinement eh hindi na mapa process for claim”. Boyet Martin po ang Philhealth Representative dun.

    1. Hi Argel, kung ganon ang policy ng PGH ay ganon nga ang ipapalakad nila — which is unfair kasi kalimitan wala naman sa pharmacy nila ang mga more expensive na meds o supplies. Case Rate naman na ngayon ang refund system ng Philhealth, meaning fixed rate, so dapat irefund ng PGH ang gastos sa meds kung meron pang natitirang balance for all or some of the meds bought outside.

  107. Hi, I was confined a week ago for 3 days because of severe stomach pain. I undergo colonoscopy, CTscan to determine the cause of pain then my hospital bill is almost 50k and the Philhealth discount that i enjoyed is 12k.
    I’d just like to ask if the discount from philhealth is correct?
    Thanks

    1. Hi Mario, based on new Case Rate list: colonoscopy: 14960 (7560 pf, 7400 hospital), CT scan: 8020 (2520 pf, 5500 hospital). I don’t know which procedure did the hospital claim. What I know is for 1 confinement, you can claim for 1 procedure and 1 medical condition, depending on the medical case. You can wait for the benefit payment notice from Philhealth so you can see how much Philhealth paid the hospital. You can ask for refund if there’s a discrepancy in your deduction.

      1. Pwede po ba yung biglaang bayad for 3years to 5 years para macover yung payment ng operation sa ospital? I meansa surgery? Thanks!

        1. Hi edra, you don’t need to, although you can always pay premiums in advance. One year in advance is good, but 2 or more years is not advisable because it’s possible that premiums will increase in the future.
          You need only to pay 3 of the 6 months prior to confinement to avail of Philhealth.

  108. Good am. Inquire lang po.

    Currently nsa hospital po ang mother ko. 1 month na po sya dun. several reasons ang diagnosis. pneumonia, pulmonary edema, stroke,kidney failure, tubercolosis and ngda-dialysis sya every week. nsa 1m na po bill namin and we don’t know when sya mkakalabas. tanong ko lng po sa ganitong cases would you know kung magkano po ba ang nako-cover ng philhealth sa bill?

    Pa-advise naman po. Thanks po.

    1. Hi Ariel, veri sori at complex na itong coverage computation for your mother’s case, so you better talk with the hospital’s billing/accounting department. Ang alam ko is for 1 confinement, only 1 medical condition and 1 medical procedure are covered. Yong dialysis, kapag outpatient, ay merong 4k coverage per dialysis, kapag meron pang matira sa 45 day allowance per patient per year (sabi mo confined na for 30 days; so 15 na lang ang natira). You can also talk with the hospital’s collection dept if you can ask help from PCSO; claiming from PCSO should be while the patient is still in the hospital or before the hospital bill is paid. I think kapag milyon na ang cost, one does not have to be poor to ask help from PCSO. Also, later on you can talk with the doctors and ask for PF discounts.

  109. hi good evening sirs.

    i am employed here in the philippines and my husband is an OFW however andito sya ngayon in the philippines for vacation. our son is due for operation (pyeloplasty).

    – magagamit po ba namin ng sabay yung philhealth namin mag-asawa?

    – magagamit po ba ng asawa ko philhealth nya kahit andito sya ngayon sa pilipinas?
    – mga magkakano po ang sasagutin ng philhealth sa surgery and hospitalization and fees sa case ng anak namin?

    would really appreciate your help para po magka idea rin kami.. salamat

    1. Hi Pia, only one of you can use Philhealth to cover for your son’s surgery. Gamitin na lang yong kung sino na yong merong complete/updated docs. Yes, your husband can use his Philhealth (Pag OFW, dapat ang surgery dates are within the validity dates in his premium receipt. Pag employed or individual payor-informal sector, 3 premium payments within 6 months before surgery). Sa Case Rate list, ang pyeloplasty coverage ay ganito: will get back

  110. Good day, tanong ko lang po kung magkano o ikakaltas ng philhealth s surgery na tatanggalin na bukol s my tonsil?
    – saka pwede po ba macover ng philhealth yun mga out-patient laboratory before the surgery?

  111. Hi. tanong ko lang kung magkano makukuha ko sa philheath kung manganak asawa ko sa lying-in costs 7,500 pesos for normal delivery. Self employed philheath member sya ang nakaka one year pa lang ang contribution nya

    1. Hi marion, 6500 ang maternity coverage sa lying-in. Dapat kausapin nio ang lying-in kung magkano pa ang babayaran nio kapag gagamitin nio ang Philhealth. Submit your Philhealth documents before discharge.

  112. Hello i would like to ask po if case rates would depend on the number of days in the hospital, or are there set days? Or ma reimburse lang ho irregardless if longer yung length of stay ng isang patient compared to another patient?

  113. Good day, naconfine anak ko last Jan.18, saturday, due to pneumonia, i asked their philhealth office kung pwede ko bayaran ang 1yr para makaclaim since individual member ako but kulang ang payment ko, and they said yes, na once nakabayad ako ay pwede na magamit uli, inasikaso namin lahat ng requirements ng monday and even asked the philhealth rizal branch the same question kung makakaclaim ako and they said yes, nagbayad ako ng 2,400, and nabawasan ng 15,000 ang hospital bill ko, but then yesterday, march 5, tumawag ang hospital and they were telling me na i need to pay the 15,000 na nadeduct ng philhealth since nasuspend daw pala ang retroactive payment ng jan.13 and they are not aware of the suspension, at di daw sila babayaran ng philhealth, was it my fault? I even actually called philhealth rizal branch before paying just to make sure na makakaltasan ako and they said yes kaya ako nagbayad, why are they doing this? If the philhealth office is aware of the suspension, bakit hinayaan pa nila kaming bayaran ang 1yr membership? Na dapat ay pinambayad ko na lng sa hospital. Btw, my bill was 30,000 that time coz they did not allow my daughter to be in a ward due to measles outbreak, that even though i know we don’t have enough money pumayag kme coz all we wanted ay gumaling ang anak ko. I hope maunawaan ng philhealth ang sitwasyon ko.

    1. Hi Abby, when you inquired, did you tell them that your child was already confined in the hospital? If you told them that your child was already confined, they should not have told you that you can register and use it for that confinement. Ang tamang sagot nila ay yong puede mong gamitin agad, pero hindi para sa na-confine na. Dapat ang premium payment ay BEFORE start of confinement. Sana kung Jan 17 nakapagbayad ng premium. Matagal nang nasa Philhealth policy na dapat ang premium payment ay BEFORE confinement.
      Philhealth unit ba ng hospital ang nag-advise sa iyo? I suggest sabihin mo na i-file pa rin nila ang claim; baka lang ma-approve, kasi yon ang advise sa iyo. As for the 15k payment, you can ask for installment payments. Or you can ask to start paying the 15k after Philhealth rejects the claim.

  114. Hi admin,

    May tanong lang po ako about sa Case Rate. Naoperahan kasi ang asawa ko (Cholecystectomy) last Dec 28 and nakapagfile kami sa PhilHealth noong Feb 4. Ang alam ko rin po kasi based sa research ko na Case Rate yung kaso namin. Now, I want to ask, 31000 din po kaya ang mabibigay samin kahit 29000+ lang yung kabuuan ng binayaran namin? Hiningi po ng PhilHealth lahat ng receipts and records namin pero I am not sure kung magkano talaga ang makukuha namin. Thanks po.

    Cecille Estrera

    1. Hi Cecille, ang 31k na coverage ay further allocated as 18,600 for medicines plus other hospital costs and 12,400 for doctors. Kung ano lang ang nagasto nio, yon lang ang marefund. Pupunta sa hospital ang excess. At depende rin sa allocation na 18600 at 12400. Example, kung sa 29k+ na gasto nio ay 20k ang meds and hospital costs, 18,600 lang ang ma-cover, or kung 15k ang PF, 12400 lang ang ma-cover.

  115. hello po!! i had my hysterectomy operation last january 21, 2014 and was discharged on january 26, 2014.. bale ang nagbayad po yong medicard insurance namin lahat.. upon discharged nagbayad po ako sa hospital ng 31,915 dahil nagkulang po ako ng requirements sa Philhealth, sabi ng hospital mag file na lang daw ako ng reimbursement,, magkano kaya ang ma refund ko pa dito? sa computation po nila 18k yong hospital bills tapos 12k sa doctors fee tapos 1915 yong miscellaneous po ng hospital.. how much refund should i get?

    1. hi anafe, tama sila na 30k ang Philhealth coverage (18k for hospital cost and 12k for PF). Sana na-advise ka na kumpletuhin ang papers mo before discharge para wala ka nang binayaran. I hope allowed pa ang direct filing ngayon. File asap kasi you must file within 60 days after discharge. Get waivers from the doctor and the hospital para ang check ay ma-issue in your name na.

  116. gud am!! san ko po pwd matanong yong sinasabing ICD CODE? yong refund po ba ng hysterectomy which is 30k, full po ba yon mababalik sa akin ng Philhealth?

  117. gud am!! mam ano po ba yong naka sulat don po sa BPN sakali matanggap ko na yon? di ba notice lang yon? after that ano na po ang susunod?

  118. to administrator of this web.

    May i ask what are the remedy of the philhealth office of;
    – the medicines order by the attending physician in the chart with good brand or in short expensive one but during the actual especially if the patients was admitted and comfined, they only tell the generic name. for example: the order of the physician, salbutamol (ventolin)nebule, in actual they change to Salbutamol (Hi-vent) nebule which less expensive than ventolin.

    – why is it the hospital bill injectable medicines per injection? example, stock of cefuroxine 500mg = 1 Vial, the physician order to a pediatric patient 6 y/0 250mg every 8hours but when the bill come out they bill per injection, which 1 vial should be 2 shot equivalent. Wala bang nagmomonitor nito?

    1. Hi gerome, sana tinanong nio yong billing department ng hospital kung bakit ganon ang computation. For billing and related complaints, I think it is the DOH that supervises hospitals. So you can email DOH if you like. Philhealth is concerned mostly with the correct application of their coverages.

  119. hi po im vianca po ask ko lng po kung cover po ba ang fracture sa philhealth? ooperahan po kc yun friend ko sa siko lalagyan ng bakal and baka mag cost daw ng 40 to 50k . kc sa anesthesia 5k bali dalawa so 10k and then yun bakal basta po ksama na po un doctors fee 40 to 50k sa poc po sya ooperahan. sana po masagot nyo to thank you po and Godbless.

    1. Hi vianca, yes, covered yan. Ask your doctor ang Philhealth coverage amount kasi hindi ko alam kung anong exact fracture type and procedure

  120. Gud am,paano po ang computation pag ceasarian section public hospital ang confinement..what if kung yung package billing is 27,000.00.Magkano ang bawas sa philhealth benefit?

  121. hello po. nag undergo po kc yung mother ko ng operation for closure of colostomy. 1st time nya po ggamitin yung philhealth nya. new member po kc sya. bayad po sya till mar 31, 2014. magkano po kaya yung mako-cover ni philhealth dto? thank u po

  122. My wife fracture her angle in an accident. She needs to undergo her surgery or just external measures and cement casting. What procedures and expenses will be covered by Philhealth? Thanks

    1. Hi Winston, sorry I don’t know the exact procedure, but in the Case Rate list, merong “open treatment of bimalleolar ankle fracture, with or without or external fixation” and similar ankle procedures at ang coverage amount ay 23,300 (12,600 for PF and 10,700 for hospital expense)

  123. Good Day! Pneumonia po ang diagnosis sa asawa ko pero hindi po sya na-hospitalized. For 1 month treatment ang reseta sa kanya ng doktor. Pwede po ba magamit ang Philhealth sa mga gamot nya? OFW po ako at dependent ko po sya.

    1. Hi Gigi, sad to say na hindi covered ang outpatient medicines. Tanungin na lang ng husband mo ang doktor kung puede siyang bumili ng generic meds

  124. Hi mag undergo kc ako ng LAPAROSCOPY pra sa ovarian cyst at HYSTEROSCOPY pra sa polyp. Kasama po kaya sa philhealth coverage yan and mag kano po kaya?? Sa east avenue po ang hospital. 1yr plng ako active member ng philhealth.

    1. Hi arian, sorry hindi ako sure sa specific procedure. May nakita akong Diagnostic Hysteroscopy sa case Rate list (5,500 for hospital expense and 4,200 for PF). Sa laparoscopy, wala akong makita for ovarian cyst.
      Merong Drainage of ovarian cyst through the abdomen (10,900 for hospital expense and 10,080 for PF). It is best that you ask your doctor so you can prepare. Baka kagaya rin ng ibang public hospital ang East Avenue na kahit sa paying-patient department ay pinapabili muna ng gamot at supplies sa labas before the procedure. So ask the hospital.

  125. hello po. ask ko lang po kung magkano po kaya covered ng Philhealth sa surgery ng dermoid cyst? kasama po ba dun ung mga laboratories na gagawin?
    OB po ang gagawa nun.

    1. Hi ann, ask your OB, kasi hindi ko alam kung anong location ng dermoid cyst mo para makita ko sa list. Ang nakita kong medical-case coverage for ovarian cyst is 7,800; hindi ko makita ang dermoid sa Medical at Procedure rate lists. Fixed na ang Philhealth coverage (merong fixed amount for hospital expense at merong fixed amount for PF), regardless kung magkano ang lab expense.

  126. Good day! Naka confine po ang Lola dahil sa stroke dito sa RENMAR specialist Hospital for 12 days na po, ang uncle ko po ay member ng philhealth at dependent Nya ang Lola ko.. tanong ko lang po required po ba kami na magbigay ng downpayment..? Kasi Bago nila tinanggap ang Lola ko nag down po kami ng P5,000 tapos halos everyday po sinisingil kami ng downpayment, umabot na po ng P39,000 ang nabigay namin na downpayment.. Ngayon po wala na kami maibigay na downpayment ayaw na po nila magbigay ng gamot dahil may balance pa kmi na P24,000, tama po ba ang policy ng hospital na eto?

    1. Hi Erwin, Philhealth-accredited ba ang hospital? Ang coverage for cerebro-vascular accident with hemorrhage is 38k. will add to this later, i’ll check circular

  127. Hi 2years na pong natigil aq sa pghuhulog sa philhealth, then this year po binayaran ko xa til dec.manganganak aq sa sept. Makukuha ko po b ung maternity benefits ng philhealth?tnx po.

    1. Hi lene, yes, magagamit mo ang Philhealth. For Individual Payor-Informal Sector, payment for 3 months immediately before delivery na lang ang required.

  128. Hello po…Philhealth member po ako, nakaschedule pong ma confine ang wife ko for chemo-therapy treatment ng stage 4 colon cancer, twice a month po siyang macocofine for 6 months at 3 to 4 days ang confinement sa govt-hospital, ask ko lang po up to what extent or how much ang macocover ng philhealth. thank you po.

    1. Hi conrado, kung Code 96408 ang chemotherapy, ang coverage ay 7,280 (1,680 for PF and 5,600 for hosp cost). One chemo is counted as 2 when deducted sa 45-days-per-year allowance (shared by all your dependents). Chemo can be can be inpatient or outpatient. Multiple cycles may be claimed in one claim form, but take note of the within-60-day-after-discharge filing deadline. Wala akong makitang colon cancer sa list, pero merong different kinds of malignant neoplasm sa colon/digestive system. Coverage for codes C18 to C19 is 14,200 (4,260 pf at 9,940 hosp). Depende sa rules, puedeng mag-claim ng chemo procedure at colon cancer hosp. There’s a rule na covered lang ang isang confinement kapag the same illness within 90 days; pero ang chemo ay excluded, puedeng sunud-sunod na chemo. Yong colon cancer coverage siguro ang under the 90-day rule.
      For a more accurate response, ask your doctor or the hospital billing or Philhealth desk. File Philhealth papers with the hospital during treatment/before discharge; direct filing with Philhealth is no longer allowed.

    1. Hi Anna, 16k ang coverage for cataract removal. Puede ring 32k for 2 eyes, depende sa case. But you need to consult first with your doctor because a pre-approval is needed.

  129. Hi

    Tanong ko lang po naoperahan ako sa Abroad for ACL arthroscopic surgery ang naging cost ng operation e almost 500K sa peso pero Company Insurance ang nagbayad, pwede po ba akong mag Claim sa Philheath and incase magkano po ang pwede ko makuha…

    Thanks

    1. Hi Tristan, ang galing naman at meron kang good insurance. If you can submit the Original official receipt or detailed statement of account (written in English), in addition to the other usual docs, then you can claim. Pero baka pag malaman ng insurer mo that you’re eligible for another insurance, baka sisingilin ka for the claimed amount (pero depende rin sa insurance policy). Kasi dito sa Phils, ang mga HMOs dito, they pay only what is not covered by Philhealth. Ang coverage for ACL is 37,180.

  130. I am OFW and member of Philhealth, I have been suferring from Hemorrhoids disease, My consultant doctor abroad was advise me to undergo operation (hemorrhoidectomy) but i do not like to do it here abroad, instead i want to do undergo operation in the Philippines. How much discount I can avail for for the said operation?

    1. Hi Marcelo, Philhealth coverage is 12,120 (6,720 for PF and 5,400 for hospital). Look for a surgeon willing to accept Philhealth coverage.

  131. .ask q lng p0h, san p0h ba dpat mas mgnda ang benefit ng phil health?? sa government o sa private hospital?? anu po pagkaiba nla pg dtng sa payment?? ang nova gen hosp p0h ba level 4 hosp?? isip q po kng san aq mas makmura, chinese gen hosp. o nova gen hosp. salamat po…

    1. Hi jen, depende sa PF ng doctor. Hospital cost in a public hosp is much cheaper than in a private hosp. Pag PF, puedeng the same or higher or lower. Ang pangit sa government hospital ay ikaw ang bibili ng meds and supplies, and then irerefund mo later on, at hindi sure kung marefund. Usually din, hindi nadededuct ang Philhealth sa PF, based sa mga comments dito, ma-private man o public). Ask for costs sa Chinese and Nova para ma-compare mo, at kung nadededuct ba ang Philhealth sa PF.

  132. Gandang gabi. Inquire ko po sana kung me maaavail ako pag nagfile ako ng claim sa philhealth ko. Updated po ang philhealth ng husband ko at beneficiary nya ko, also updated din naman ng philhealth ko. Isa po akong ofw na nag undergo recently ng laparascopic surgery and cbd exploration sa isa pong private hospital sa ibang bansa. Total bill ko po ay umabot ng around 340,000php lahat lahat na po include gamot, surgery , single private room charge at mga test. Then bale ang binayaran po na lng namin is around 90,000php kasi nacovered po sya ng insurance ko po dito..ngayon po pwede po ba ako mag aaplay for claim at mga magkano po kaya ang makukuha ? Salamat po sa reply

    1. Hi Joy, sori, wala akong makitang laparoscopy to explore the common bile duct sa Procedure Case Rate list ng Philhealth. Merong mga laparoscopy sa list pero hindi sa CBD. I-file nio na lang with Philhealth within 180 days from discharge date.

  133. Hi, member yung sister ko ng philhealth.. meron syang goiter at kailangan tanggalin sabi ng doctor sa PGH, yung rate na binigay sa kanya ay 90K sa FEU Fairview… magkano po kaya ang mababawas dun sa philhealth?

    1. Hi rosalnd gineta, ask your doctor/hospital para sure. Hindi ko sure if your procedure is thyroidectomy. Ang coverage for thyroidectomy is 31k (12,400 for PF; 18,600 for hospital)

  134. Hi po// i want my two boys to be circumsized ng sabay… sakop ba sila ng philhealth ko pareho? and if gusto ko laser sila? ok lng din ba? magkanu maclaim ko if ever? thanks…

    1. Hi Bonsai, ang coverage for circumcision is 1260 (840 PF and 420 hospital/clinic cost). Find an accredited doctor and hospital/clinic.

  135. na-confine po mother ko for 11 days + 4 hemodialysis session during the confinement. Ang question ko po, ilan ang total days of deduction sa 45 days Philhealth benefits? kasi po sa dialysis center na pinag papadialysan ng mother ko ay 15 days ang ginawang deduction. Ilan po ba tlaga dapat? may nagsasabi sa akin na dapat daw ay 11 days lang. sayang din naman po ang 4 days. meron po ba ako pwede makuha sa Philhealth na magsasabi sa dialysis center na dapat 11 days lang ang ideduct, not 15 days?

    thanks

  136. Good am po ask ko lang po sana im philhealth member since 2008 employed po aq that time until 2011 po 2012 january until now di q na po nahulugan ung philhealth q dhil nagstop na po aq sa work pwede ko po bang ituloy ung buntis po kc aq now manganganak po aq duedate q po nov.26 c.s po aq kaya need ko po bayaran sana ung philhealth po magkano po kaya babayaran q ?

    1. Hi jaja, register at Philhealth, check Informal Sector and pay Apr to Oct 2014. 200 pesos per month. Puedeng 3 or 4 months muna, and then pay again in Jul.

  137. ask ko lang po kung magkano po nababawas pag na opera sa gall bladder (tinanggal ung bukol) cancer case po… may Tuberculosis din po

    1. Hi anna, if the procedure done is gallbladder removal or cholecystectomy, coverage is 31k (12400 for PF; 18600 for hospital). I assume na lower coverage kapag cyst or lump removal only. I don’t know your exact procedure, so ask your doctor.

  138. Good day! Pwede po bang makakuha ng mdr sa mga satellite office gay ng sm sucat? At kung sakali po na until march 2014 lang nabayaran na contribution, pwede po ba magbayad ng april to june 2014 as voluntary contribution na maa-active agad ang member gayang sa mga ofw? Thank you and more power!

  139. Hi ask ko lang, naka-confine ngayon yung mother ko sa isang private hospital and ang sakit nya is highblood and diabetes. Sa nakikita ko kasi hindi under ng case rate yung sakit nya. Paano po kaya malalaman kung magkano ang masho-shoulder ng philhealth. Thank you and Godbless.

    1. Hi Vheng, merong hypertension. Coverage is 9k (2700 for PF; 6300 for hospital). Merong diabetes, pero there are too many types on the list (coverage ranges from 6800 to 12k+ to 15k+. Baka 1 illness lang ang ma-cover. Ask billing dept. God bless din

  140. Ask ko lang po if what rate case ung ameloblastoma? Needed na lagyan ng bakal ung left mandible costing 80k. I have to undergo surgery. Ask k lang po if magkano ang covered ng Philhealth because the doctor inform me to prepare 200k. Tnx

    1. Hi Fatima, ask your doctor your total cost if you use Philhealth. The procedure is costly, so you have the right to know all your options. I have the Case Rate lists, but I can’t find ameloblastoma. I can see jaw, mandible, etc. but it’s your doctor and Philhealth physicians that can accurately check the lists.

  141. Hello po. nag-undergo po ako ng tympanoplasty last Saturday. ang nakuha lang po naming ay yung institution fee/hosp. fee of 17300. ndi po naming naavail ang pf which 13440. dapat po ba ang maccover ng philhealth ay pf + hosp. fee? total of 30,740? .thanks po. 100k + po ung surgery..

    1. Hi bryan, yes, dapat kasama sa deduction ang PF. Kaya lang ang mga doctors kasi gusto nila mabayaran agad sila, so hindi binabawas agad ng many hospitals. Ask the hospital kung irerefund nila yong 13440 sa iyo pag natanggap mo na ang benefit payment notice (BPN) from Philhealth.

  142. My sister will undergo thyroidectomy next week. Her doctor asked her to prepare 200k. 100k dun PF pa lang po. wala pa dun sa cardio, anesthesia at kung sino pang doctor. Pero base sa case rate, 31k lang po. Bakit po kaya ganun?

    5 nodes ang natagpuan sa leeg nya kaya di pumayag ang doctor na di paoperahan. Pag sa government hospital po ba, malaki din ang magagastos namin?

    1. Hi Ghia, 46,500 ang coverage ng thyroidectomy with radical neck dissection; pero kagaya nga ng sinabi mo, small coverage pa rin. Try consulting with another doctor at the pay department of a government hospital.

  143. Hi. My dad is still in the hospital for pneumonia and hemo dialysis. He is 66 yrs old? Will he still get discount coz of his age? If so, magkano po yung discount. Thank you

    1. Hi Christine, the 20% senior citizen discount is only for certain medicines. Submit his Philhealth papers asap to avail of Philhealth deductions

  144. hello po. ask ko lang po sana ang husband ko schedule for kidney stone and gallstone operation. pwede po ba malaman kung magkano case rate ng kidney stone removal at gallstone? tnx po…

  145. Hello please enlighten me on this…

    My mother was hospitalized and went through total hysterectomy procedure (TAHBSO) last January. When I settled our bill, a Philhealth representative in the hospital assessed that Php 18,000 will be deducted from our bill. Just yesterday, I received the benefit payment notice and learned that the amount Philhealth reimbursed to the hospital is Php 53,400.

    Provided that 40% goes to PF and 60% goes to facility, aren’t we supposed to get 32,040 instead of just 18,000 deduction?

    Looking forward to your response. Thanks

    1. Hi jeffrey, pay your premiums until you turn 60. At age 60, you can apply for free lifetime membership as long as you’ve paid at least 120 contributions.

  146. Hi, please shed me some light about po sa ittanong ko. Yung sister in law ko po nanganak sa bus, kasi papunta na sya sa lying in kung san dpt sya manganganak. Hindi na po inabot kaya sa bus na sya nangank. Lahat sa bus ginawa exept sa pg kuha ng placenta nya. Then, nung una ung mga nurses dun and midwife tinatanong kung meron sya philhealth. Sbe nya meron. Then, nung ngpasa na requirements para magamt philhealth. Sabe ng billing hindi daw po magagamit kasi nangank sya sa transit, nakaconfine lang daw sya sa hospital. Ang nakakaloka po kasi dun. Confine lang po. Mga 2days lang ng bill cla ng 23thousand. Then ung professional fee ng doctor 8thou umabot. I.e lng na dalawang beses ginawa. Hm. Hindi po ba talaga mgagamit ung philhealth pg ganun ung case na sa bus nangank hndi sa hosptal?

    1. Hi dez, there’s validity in the reasoning that the hospital can not apply the normal delivery benefit, because they did not deliver the baby, but the doctors could have written a diagnosis that can be covered under Case Rate, like something related to the placenta if this was removed at the hospital. Newborn care benefit should have been applied.

  147. Gud morning po. Kafifile ko lang po ng philhealth ko ngaung june 2014 and 12months po ang binayaran ko. Buntis po ako at ang due date ko po ay sa december 2014. Ask ko lng po kung magagamit ko po ba yung philhealth ko sa panganganak ko. Thanks po.

  148. Hi,
    my mom need a gall bladder stone surgery. She is 65 years old and one of my dependent in philhealth. How much will the philhealth covered for the operation… Hope to hear from you soon

    1. Hi alona, if cholecystectomy (removal of gallbladder to remove gallstone) is performed, coverage is 12400 for PF and 18600 for hospital costs

  149. hi po.. ask q lang po if wat are the requirements na ipapasa q para magamit q po ung philhealth ng asawa q sa panganganak q this comung aug/sept2014.. wla po k sya dito sa pilipinas eh, pero aq po ung beneficiary/dependents nya.. tsaka ask q na din po if ilang percent or how much ung ma-le-less ng philhealth pag nanganak aq as CS.. twins po kc anak q.. tsaka ask q na din po if wat level ba ng hospital ung taytay doctors.. thanks po and hope masagot po lahat ng questions q.. thanks po ulit at God bless! :) tsaka po pala, magpapatali na din aq kasabay ng CS may bawas din po ba un? tsaka ung sa twins q sa nursery package? thanks much!

    1. Hi ninay, the coverage for indicated CS is 19k. For newborn care, it’s 1,750. Coverage for CS with tubal ligation is the same as CS only, which is 19k. Ask your husband to send you a copy of his OEC/Philhealth receipt. God bless too

      1. hi po ms. nors.. this is ninay again.. pwede po bang sa office nlang aq kukuha nyang mga yan? ung oec po ba is overseas employment certificate? so i need to ask a latest contribution copy sa office nila? seaman po kc sya.. tsaka ung sa new born package po ba is each sila kc twins po eh, or isang less lang silang dalawa? thanks po! God bless :)

  150. Good day! Ask ko LNG po,
    Dba pag CS – 19K , public hospital xa . 20k dw kasi dun walang pHealth,
    Sa labas dn dw bibili nung gagamitin ky baby,
    Pwede po b yun ? Na Yung magagamit LNG s phEalth ko is Yung gastos LNG sken ? Yung ky baby di mkksma sa pHealth ko ? Like newborn and Iba ? Pwede po b un? Di nman xa aabot sa 19k ?
    Thanks po ..

  151. Question lang po. pag nakuha na po ba ung money sa philhealth may ikakaltas pa po ba ung hospital at ung cheque po sila ung mag papalit nun sa banko at ibibigay siya after 3 months. tama po ba ung procedure na ginawa nung hospital na un? please advise po. salamat

    1. Hi Charlyn, the correct procedure is this: the hospital deducts the total Philhealth coverage from the hospital bill. Did you submit your Philhealth papers to the hospital before discharge? But they did not deduct? Wait for your benefit payment notice from Philhealth, then get your refund from the hospital.

  152. magandang umaga po. Naoperahan po last Sept 24 2011 for kidney and bladder po. Pwede po ba ipa reimburse sa philhealth? nung ibang gastos? yung hospital po is VRP(victor r.potenciano)
    kung pwede po anu po yung mga requirements na kelangan? salamat po

    1. Hi jeniline, do you mean year 2011? It’s too late. In the past years, members only have 60 days after discharge to file a claim. This year, members should submit their Philhealth papers to the hospital upon admission or before discharge.

  153. good am po.ask ko lang kung paano ako avail ang philhealth.kasi hindi po,ako member.puede pa ba ako mag member sa ngayon may clearance for admission na ako,paano gagawin ang mga proseso

    1. Hi may, this is a delayed response, so I hope you have asked other people. You should have paid 3 months within Dec 2013 to May 2014.

  154. Hi sir! Gusto ko lng po malaman kung magkano ang pwede macovered ng philhealth kapag bypass operation po. Member po ang asawa ko ng philhealth.
    Naconfine po sya ng 2 weeks sa phc and may mga gamot din po kami binili habang nakaconfine sya. Marereemburse po ba namin yun?

    1. Hi jocelyn, PHC has a Philhealth desk. You should go there and ask, for more accurate answers. In the Procedure Case Rate list, bypass graft ranges from 37,600 to 46,500. A Medical Case Rate coverage may also be applied. You can also ask help from PCSO (it’s best to apply at the time you have not yet paid a big part of the bill). Ask help from the PHC’s PCSO desk. PCSO is a big help.

  155. My philhealth po kami,kung sakaling gamitin ko sa ospital at gusto ko magprivate room,pwede bang charity doctor lang ang doctor ko para walang bayaran?

    1. Hi joanjoan, charity doctors work only in the wards/charity sections. Philhealth also has a fixed coverage rate for each illness covered, regardless of the kind of room you stay in and regardless of your total bill.

  156. Hi im jenny, i have endometrioma in my right ovary my dr. Sa las pinas doctors Said na abot ng 60-70k ang operation. My health card ako na ang limit is 75k.. ask ko lng po kung macocover ba ng buo yung surgery with my philhealth and healthcard? Btw im 2 1/2 yrs. Na member ng philhealth

  157. Hi i was diagnosed with endometeioma on my right ovary, sinuggest ng doctor ko n kelangnan ng ipasurgery which will cost around 60-70k. I am 2 1/2 years yrs. Na member ng philhealth. Meron po akong healthcard na 75k ung limit per illness. Ask ko lng po sana kung papatak ng 70k ang total bill ko, mccover b yun lahat with my philheath and healthcard? Kelangan ko po kaseng malaman before i decide na mgpasurgery para makapprepare din ng pera..thank you..

    1. Hi jenny, yes, if your total bill is 70k, Philhealth will cover about 20k, and the rest, around 50k, will be covered by your HMO card. But ask your doctor, so that you can be sure that your doctor is Philhealth-accredited and the hospital is Philhealth-accredited. If you like, you can also ask another doctor in the same hospital or another hospital. When finally decided, submit your Philhealth papers upon admission, to be sure.

  158. Hi I was diagnosed of having fibrocyst at my left breast. The doctor said i need to undergo EXCISION so they can do biopsy. Covered po ba ng philhealth ang ganitong case and if yes how much will be deducted to my hospital bill if ever? I working on a private company and continually pays my contributions since November 2013 up to present. I’m planning to do the procedure next month July 2014. Is it possible?

    1. Hi Carla, yes, that’s covered and you’re eligible. But find a doctor who’s willing to deduct your Philhealth coverage. Some doctors assume you’re going to pay them in cash.

  159. Ask ko lng po. Magkano kaya ang icocover ng philhealth para sa nasal polyps removal. 60-80k daw po un procedure. Thank you

    1. Hi luisa, sorry I’m not sure because MRI is a diagnostic procedure, and if this is done separately from a treatment procedure, I know it’s not covered. But ask your medical facility.

  160. hi gusto ko lang po itanong magkano makukuha ko kc kailangan operahan ang birthmark ng anak ko kasi lumaki yun ang tinatawag na (strawberry human juma) ako po ay isang ofw …

  161. Mam,papanonaman ako maraming sakit piro di naman ako naoospital kasi puroconsulta lang at bili ng gamot hirap na ako wala trabaho at may edad na nagbabayad po ako sa pilhealth mula pa ng ako ay OFW pls.help
    now nga may liver cancer na ako at may High blood pa.

  162. member po ako ng pilhealth,sagot ba ng pilhealth kung pakunsulta ako sa doctor matagal na akong member dati sa SSS pa yon ..

    1. Hi diosdado, sad to say, Philhealth does not refund outpatient consultation. It covers hospitalization for covered illnesses and procedures

  163. Hi, i would like to inquire how much will be dedected to the hospital bill in the philhealth if the case is hyperactive airways.

    Thank you in advance.

    1. Hi Chris, if this is the diagnosis: Code J68.3 — Hyperactive airway disease, coverage is 14,700 (4,410 for professional fee and 10,290 for hospital expenses)

  164. hi po ask lang po f pd pa po bang mahulugan yung 3months gap n payment sa philhealth,and pd pa po bang magamit sa medical treatment yung philhealth kht may unpaid payment contribution po and member

  165. i po ask lang po fhpd pa po bang mabayaran yung unpaid contribution ko,khit my gap na po and pd po bangmagamit ng asawa ko ang philhealth nya sa medical treatment kasi sched po sya for cs nitong july 16,2014 sa quirino hospital,ang hinihingi po ng hospital eehhh 25 to 30k po, tama po ba yun price n hinihingi nila para sa public hospital

    1. Hi arjhay, if your wife delivers in July, she should have paid at least 3 months within Jan to June 2014. The deadline for Apr to June payment is June 30. Ask others too.

  166. hi ask lang po f kaya pa po bang mabayaran yung unpaid contri ng isang member khit 7months n po ang nakalipas,..and pd pa po bng magamit ng asawa ko ang philhealth khit may di sya nbayaran na contri,.sched po kasi sya for cs this july 16,2014 sa quirino hospital,hinihingian po kame ng hospital ng 25 to 30k,gawa po ng wala syang medical checkup doon,tama po ba na ganun ang amig babayaran do sa ospital and magkano po ang mababwas f magamit nga nya ang philhealth nya,..

    1. Hi arjhay, sorry you can no longer pay for past quarters. Your wife qualifies if she has paid at least 3 months within Jan to June 2014. If you like, you can ask Philhealth if you can avail if you pay 1 year in advance.

  167. hi po, kpapanganak ko lang po nung july 9, 2014 . kaya lng po di ko pa po npa newborn screening si baby . magagamit ko po ba ung NBS package ng philhealth khit sa ibang hospital na po ako magpa check up at khit po 5 days old na si baby ? thanks po.

    1. Hi Robbie, sorry I think you can no longer claim for newborn care coverage. The rule is within 3 days. But ask your pediatrician.

  168. Hello there. My daughter was rushed to the ER kasi ang taas ng lagnat and due to febrile seizure, pero nirelease din po kami after several hours. Nagbayad po kami cash kasi walang insurance. Pwede po ba yun mareimburse ng Philhealth yung binayad namin?

    Employed po ako and up to date uyng philhealth contributions ko. thanks

  169. Good day poh..may pmangkin poh ako n hydrocephalus..mgkano poh mbyaran pgmay gmit n philhealth s parents?salamt poh..

    1. Hi Janice, ask your doctor. In the Case Rate list, the coverage for hydrocephalus is 17,300 pesos (5,190 pf; 12,110 hospital expense). There’s also coverage for craniomegallic skull reduction surgery if it’s performed, ranging from 37,800 to 53,400, but ask your doctor.

  170. hi,ask ko lang po kung may binibigay sa may sakit na U.T.I ang philhealth.Naconfine kasi yung 1 month old baby girl koh.

    1. Hi Chii, yes. Submit your Philhealth papers to the hospital at least 1 day before discharge. No more direct filing with Philhealth.

  171. Ask ko lng po pau ggamitin para sa thyrodial ceck up un magpoates t ng dugo etc. I hope you can answer me .thank you very much.

  172. hello po ask ko lang po if pwede ba ulit maka avail sa SP program Yolanda ng philhealth na confine po anak ko last july 13 due to pneumonia po then na confine po sya ulit ngayon august 4 due to pagsusuka at diarrhea po

    1. Hi alma, if you were able to avail before, then you can avail again for this confinement. Talk with the social welfare officer of the hospital.

  173. Good afternoon po,

    ask lang po qng mga mgkanu po kaya ang mkakaltas sa bill, mag undergo po sana ako ng tonsillectomy;

    thank you po ^^

    1. Hi Trisha, Tonsillectomy, primary or secondary — 18,000 (9,600 hospital cost; 8,400 PF)
      Tonsillectomy, and adenoidectomy — 18,000 (9,600 hospital cost; 8,400 PF)

    1. Hi Malvencio, Tonsillectomy, and adenoidectomy — 18,000 (9,600 hospital cost; 8,400 PF)
      Tonsillectomy, primary or secondary — 18,000 (9,600 hospital cost; 8,400 PF)

    1. Hi Christine, Amoebiasis, Hepatic 10,000 pesos (7,000 hospital cost; 3,000 PF)
      Amoebiasis, Nonhepatic (4,200 hospital cost; 1,800 PF)

  174. hi my brother has been to hospital in emergency..he has a high blood pressure but the doctors doesnt keep him for observation just make some test xray bloodtest and more other.he paid 5k for all of it.. how much philhealth could pay him back?

    1. Hi Arlene, sorry, for high blood pressure, if he was not confined and treated for hypertension or other diagnosis, he cannot be covered by Philhealth. Ask others too

      1. Hi! I have hemangioma since birth and im planning to under an operation. My surgeon told me to prepare 170k for the operation excluding the laboratory fee. If ever, how much can be deducted if i’ll use my philhealth?

        1. Hi eds, I can’t see hemangioma in the list of Procedures; I see it in the Medical List, and the coverage is only 9k. There should be a name for the procedure and its coverage, so ask your surgeon.

  175. Pls help..my baby was admitted in the hospital last August 4 due to neonatal pneomonia.shes been in the NICU for 5 daysusing oxygen.compressor.na suction p siya..after 5 days of giving her anti biotic na xray ulit siya but the lungs still not clear and shes not responding sa gamot kya pinalitan ulit which it takes us to 6days again in the hospital..Now the problem is isnt not my baby in a high risk pneomonia?our hospital bill was 62,152 pesos at ang binayaran lng ng Philhealth is 12,700..I was so disappointed sa benefit na bnigay ng philhealth.Iwas paying my philhealth for how many years.tapos eto lng binigay nla?
    I went to the philhealth office..sabi nla kasalanan daw ng doctor kc hindi sinulat na high risk at wala na daw mggwa..
    But I protest..they cannot just tell me na.wala na magawa..in fact dumadaan sa mga officer ng philhealth ang bill muna.So dapat nkita nila lhat ng ginamit kc andon naman lhat.sa bill..
    So please give me an advice on what to do.kc they cannot just tell me wala cla mgawa.
    I NEED MY MONEY BACK AND.IM WILLING TO SUE THEM OR PUBLISH THEM KUNG TLGA GANITO ANG.PHILHEALTH

  176. good morning po. Nagkaroon po ako ng philhealth point of care last august 10 yung mismong hospital po ang nagbigay sa akin ng form at nagamit ko rin po kaagad dahil nagpaligate po ako, ang tanong ko po wala po ba ibibgay sa akin na member card or ID or paano ko po malalaman na member na ako hindi ko naman po alam ang ID number ko… maraming salamat po

    1. Hi mitch, you’re included in the patient list of the point of care program of the hospital. Valid until Dec 31 2014. But you must ask the hospital if you’re sponsored until Dec 2014. There’s no ID because it’s not the regular Philhealth membership.

  177. hi ms. nora. how much usually is the cost of appendectomy in both public and private hospitals? accdg. po sa benefits posted above, 24k is the deduction from the bill. is PF included in the benefit? thank u. Godbless

    1. Hi TinTin, you have to ask hospitals near you about their appendectomy rates. The Philhealth benefit for appendectomy is 24,000 pesos (9,600 for PF and 14,400 hospital expenses)

  178. hi ms nora. how much usually is appendectomy in both public and private hospitals? accdg. to the case rates and benefits posted above, 24k is to be covered by phealth. is PF for doctor included?. thank u po.. Godbless

    1. Hi TinTin, the coverage for PF is 9,600; 14,400 is for hospital expenses. Ask your doctor about costs and Philhealth coverage so you can prepare.

  179. good evening, my mother was admitted at slu in baguio due to stroke. how much will be deducted from our bill? will the meds we bought outside be reimbursed by philhealth? thank you.

    1. Hi evangeline, the coverage for stroke is 38,000 pesos (26,600 pesos for hospital expenses and 11,400 pesos for PF). If the 26k allocation is used up fully by hospital expenses, then you can no longer refund meds bought outside. You might be able to get a second case rate benefit (50% of second procedure qualified for second-case-rate coverage).

  180. Hi may i ask, mama will have thyroid surgery this october. she will use my papa’s philhealth. papa last paid in 2012. if papa pays philhealth this month, can my mama use it? how much is the coverage for thyroid operation?thanks

    1. Hi richelle, yes, your papa should pay Jul to Sep tomorrow or asap and get his MDR. Coverage for thyroidectomy is 31k; coverage for other types of thyroid surgery are either lower or higher. Ask your doctor.

  181. Hi, may i ask, my mother was admitted at nkti last august 2013. Twice she had hemodialysis, and we paid cash. later on, when she was being discharged, i came to know that she’s a dependent of my father who has pHilhealth. so i paid 150php to the hospital. i ask if i can reimburse what i paid to nkti for hemodialysis?

  182. Hi.. I was diagnosed with chronic Osteomyelitis and were scheduled to undergo 2 surgical operations in two months time. My first surgical operation was is Sept. 8, 2014 and next will be anytime in the last week of October 2014. About Php 11,000 were deducted form our hospital bill. Will I be able to avail again for my next scheduled operation provided that there will be no lapse in my contribution?

    1. Hi Joan, there’s a 90-day single period of confinement rule, which says that in cases of admissions and re-admissions for the same illness or procedure within a period of 90 calendar days, only one confinement will be covered, except hemodialysis, chemo/radiotherapy and cataract removal. Ask your doctor/hospital.

  183. Ms.Nora Gud day ! My daughter was confined at St.Gabriel Med.Center in aklan last May 7, 2014 and the findings is pneumonia. We paid the full hospital bill including the doctors fee amounting to 12,990 in cash. The BPN showed 15,000 refund from Phil health. The hospital said they need to deduct the PF which is 4,500 even we’ve already paid the 2,500 PF as part of the full hospital bill and we have the O.R. Is that how it should be? Tnx and God Bless.

    1. Hi Mitch, the hospital should refund you the full 12,990 pesos because that’s the amount you paid, and that’s the amount on the OR, and the 15k coverage is enough to cover what you spent. But doctors getting the Philhealth PF coverage as additional to what they charged (in your case, it’s 2,500), is common. It could be the hospital getting the amount or the doctor. What they usually say is that, for example in your case, their total PF is 2,500 from you plus the 4,500 from Philhealth. You can write Philhealth or Philhealth’s Facebook page.

  184. Is 70% what we can refund? Our bpn says 7500. Pero 70% w/c is 5250 was refunded by the hosp. The 30% w/c is doctors fee can’t be refunded according to them. Is that true?

    1. Hi Shane, sad to say, that’s what has been happening in many hospitals. They say that the PF from Philhealth is additional to the PF initially charged for PF. You can write Philhealth or comment on Philhealth’s Facebook.

  185. my case is amputation and my hospital bill was 140k 70k for hospital and 70k for doctors fee. how much will be my Philhealth deduction?

    1. Hi harvey, what part was amputated? I checked the list, and there are different types? sad to say that the rates shown are too small compared to your bill.

  186. Dear Nora, My wife has undergone a major surgery due to Intra-Ventricular Hemorrhage, four days after removing the “drain tube” in her head, she had to go again in an operation to re-insert the “drain tube” as she become dependent on it.. after 5 days, the doctors asked to operate on her for the third time to place a “subgaleal shunt” instead as the “drain tube” is prone to infection since it is exposed. She was also operated for “Tracheostomy”. We are both staying here in Malaysia. Any advise on the financial benefits from Philhealth will be very much appreciated. God Bless to people like you..

    1. Hi R. Felix, about the amount of Philhealth coverage, it’s sad that amounts now are fixed for every type of procedure or illness, regardless of actual hospital costs. Only the major procedure done is covered; but a second procedure can be covered, depending on the case. Anyway, you can file your claim within 180 days after discharge. Requirements:
      PhilHealth Claim Form 1
      Member Data Record (you get this from Philhealth)
      Your Philhealth premium payment OR (validity dates should cover confinement dates)
      Statement of account and other receipts (from hospital)
      Medical certificate indicating final diagnosis, confinement period and services rendered (must be written in English language, or translated to English)
      I checked Philhealth’s Procedure Case Rate list, but I can’t find “ventricular hemorrhage”, so I can’t see the coverage amount. Other terminologies might have been used by Philhealth. Here’s the Philhealth Procedure Case Rate list, if you have time to check. You can use Ctrl plus F to search. Thanks for wishing me blessing. May God continue to bless you and care for you as you and your family overcome this challenge.

  187. my husband plans to have surgery for his goiter this november 2014 at a govt hospital. Can he avail of no balance bill? He is jobless and I am an ordinary employee. We are active philhealth members.

  188. I know someone who will undergo laparoscopic cholecystectomy, but the one who will do the procedure is from a private institution and it will be done on a public hospital. Can she avail of her benefits? Or the doctor will be paid in cash separate from the hospital bill? Thank you. Your advice will surely can help.

    1. Hi Cha, is the hospital and the private doctor both Philhealth-accredited? If yes, she can avail, but it’s most likely that she will pay the private surgeon. She should ask.

  189. Hi, i was hospitalied a week earlier with disgnosis of pneumonia moderate risk with all the deductions but is returned 2 weeks with pneumonia high risk at the same hospital. Will i be able to avail any discount?

    1. Hi gil, sad to say, you might not be covered because of the 90-day single confinement rule (only one coverage is paid if the same diagnosis within 90 days). Ask others too.

  190. Hello, I have a plan po sana na magmember ng Philhealth this month. I’m currently pregnant and this month po ang expected na panganganak ko. If magbabayad po ako ng 2,400 for the whole year payment magagamit ko ba agad ito?

  191. good day po, ofw po brother ko uwi po sya pra paopera hemorrhoids nya. Updated po Philhealth nya cover po un. Mga ilan percent po assistance mkuha nya s Philhealth. Thank upu

    1. Hi Liza, coverage for hemorrhoidectomy is 12,120 (5400 for hospital costs; 6720 for PF). It’s fixed rate; no longer % of costs.

  192. hi there, my mother in law was admitted to chong hua under emergency admittance for enlarged heart problem. she has been in icu for 2 days and has had angiogram , cathertisation and lab etc . results show no heart blockage. problem diagnosed as over active thyroid and urinary tract infection. the bill is 179,314php for 2 days. she gets senior discount and they say the balance is 125,000php. I have paid 35,000php down payment. she does have philhealth already for previous treatment which was only minor. the bills seem outrageously high to me for no real procedure? what help do you think I may receive from philhealth to pay the balance? best regards, john

    1. Hi john, yes, compared to these rates of Phil Heart Center, http://www.phc.gov.ph/services/treatment.php , those of Chong Hua, nothwithstanding its non-profit status, are costlier. Obviously, private rooms trigger higher hospital and PF rates. Have they filed Philhealth with the hospital so they can get some deductions? The patient can again use Philhealth even if confined previously within 90 days because her previous treatment is different.
      Direct filing by member with Philhealth is no longer allowed.

  193. Hello, I have a plan po sana na magmember ng Philhealth this month. I’m currently pregnant and this month po ang expected na panganganak ko. If magbabayad po ako ng 2,400 for the whole year payment magagamit ko ba agad ito?

  194. Good day, my child is confined in st therese. We filed philheath and they will deduct only 10%. How much should they deduct for dengue case?

  195. Greeting! my husband works in canada for about 10 mos,2 days ago he underwent angioplasty (heart surgery). Now hes in recovery process,expenses paid provided by the company. How much will be the claim from philheath in this case? Thanks

  196. Hello. my husband is ofw. A document is required to activate his philhealth. If we can submit the document this m0nth and pay 2400 for one year, when can we use Philhealth? I plan to have thyroidectomy. Thanks

    1. Hi ice, did they require proof that he is OFW, authorization letter plus a copy of his ID? Yes, after paying 2,400 and after getting your husband’s MDR in which his member category is OFW and your name is written in the MDR as dependent, you can use it immediately. For OFWs, you can use Philhealth within the validity dates in your receipt. For example, you pay on Nov 28, and your receipt shows Nov 28, 2014 to Nov 28, 2015, you can use Philhealth within those dates.

  197. Hi I just want to know if the reimbursable part of philhealth is really a privilege of a doctor or the patient?There are doctors who transact to a senior citizen saying that his professional fee was net of 20k plus under the table of 5k deposit..the patient hoping that there could be at least reimbursement from philhealth was shocked when saw the billing because the true cost of the doctor was about 50k…are there remedies for this kind of problem?

    1. Hi Kapeking, it’s hard to read about doctors not being forthright with their patients. i agree that they should be paid well for their services, as they spent much for their education, and they’re treating human bodies. But they should be honest. They should ask their secretary to explain beforehand to patients about costs if they’re not comfortable discussing money with patients. This doctor should have told this senior citizen his rate beforehand. But this senior citizen can still talk with the doctor, explain his situation and ask for a discount. About your first question, Philhealth primarily is for patients. But hospitals and doctors benefit from Philhealth too, as they get more patients if they offer Philhealth coverage.

    1. Hi Cherry, yes, Nov 28 is 6 days away, so he can use it. He should pay asap, on or before Nov 28, for the next 3 or 6 months so his membership will continue to be active

  198. Hi, inquire ko lang po yung sister ko once na nagstart sya sa Isang bpo industries Binigyan na sya ng HMO card then nagkaroon sya ng acute pancreatitis and kaka one month pa lang po nya. As per your list ang AGE ( acute gastritis) ay 6000, how about po if acute pancreatitis how much po fixed rate, at ito ba ay sasagutin ng HMO nya? Salamat po

    1. Hi Arlene, Philhealth will cover a fixed rate (12,600 for acute pancreatitis), and the balance will be paid by the HMO, as long as the balance does not exceed her HMO plan limit.

  199. Hello, My baby was confined due to pneumonia for only 24hrs at the hospital. We got out against doctor’s advice. But I still filed my philhealth after we were discharged. Can I get the whole 15k case rate? I paid 3k in addition to my downpayment of 5k, totalling more than 8k. Thanks

    1. Hi Farlie, you should have not paid anything. Philhealth benefit should be deducted before discharge. But if the hospital told you they will refund you after Philhealth pays them, they will refund you only the 8k plus that you paid.

  200. good evening yung baby ko nagka neonatal pneumonia magkano kaya mababawas sa bill ko? tpus nagkaron pa ng congenital heart disease

    1. Hi daniel, coverage for moderate pneumonia is 15k; coverage for congenital pneumonia is 12,600. coverage for congenital heart disease is 11,600. But there are rules applied in case of 2 or more illnesses, so ask the hospital.

  201. Hi ask ko lng anu po dapat gawin kasi end of contract na ako this december and im giving birth this march kailangan ko po bang hulugan yung remaining 3 months para maka avail ng benefits na 8000 maternity benefits.

      1. Hi lea, ask for cert of premium payment from your employer for last quarter of 2014 and pay for Jan to Feb 2015 so you can avail.

  202. Good afternoon po, my husband had his urgent bypass (coronary artery bypass graft – 4 vessel) last september this year sa philippine heart center. Di na po sya nag-avail ng Z-benefit from philhealth kasi matatagalan pa daw ang processing kaya matatagalan pa din syang mai-bypass (although di din naman sure if makaka-qualify sya.) Besides po ng findings through angiogram ung heart disease nya eh nagdi-dialysis pa sya, actually it was only on his 3rd session of hemodialysis when he experienced angina that’s why he was referred to philippine heart center. Upon deposit of nearly p350,000 he was bypass and he stayed there for 34 days. Upon discharge his bill amounted to p1.1 Million. We didn’t expect that the discount he got from philhealth was only p21,000 for bypass and p24,500 for 7 sessions of hemodialysis.(Not to mention the other 7 sessions of hemodialysis which were paid in cash when he had his credit suspension from the hospital) Ang question ko lang po ay — may refund pa kaya sya from philhealth or talagang itong p45,500 na lang? THANKS PO!

    1. Hi Anya, based on the Case Rate list, the coverage for coronary artery bypass, vein only — 4 coronary venous grafts is 58,800 pesos (37,800 for PF and 21k for hospital costs). Ask Heart Center for refund of the 37,800 pesos. Heart Center has Philhealth personnel, you can ask them if coronary artery bypass has a second-case deduction, so you can have additional deduction. It’s really frustrating that Philhealth provides only 58,800 for bypass.

  203. Hi my husband is ofw and was able to use his philhealth last nov 24 at a private hospital due to preterm labor. after 2 days i was discharged and used my husband’s philhealth. The hospital said I can use Philhealth again when I give birth because the diagnosis are different. I’ll have normal delivery and my due date is dec 13. Can I use again my Philhealth? Will 6500 be deducted for normal delivery? Thanks

    1. Hi Retchel, the hospital said you can use your Philhealth again, so they must have written a diagnosis which is different from normal delivery. If they wrote a diagnosis like preterm bleeding or preterm pain, then you can use Philhealth again, as normal delivery is different from preterm illness. At a hospital, the deduction is 5k (3k for hospital expenses and 2k for PF). Submit prenatal ORs worth 1500 to the hospital together with your Philhealth docs so Philhealth will send you a 1500 check.

  204. Hi, how much is philhealth deduction for pedia PDA ligation? Also, is there an HMO that covers congenital heart disease? Thanks!

    1. Hi Des, I see only this in the Case Rate list: Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure. Coverage is 18k (8400 PF; 9600 hospital costs). About HMO coverage: If your plan covers pre-existing diseases and if there are no restrictions on heart diseases, then your HMO should be able to cover your child’s treatment up to your HMO limit. You can call your HMO.

  205. hi I gave birth nov. 26, had cs, and my baby had surgery. we spent so much at the hospital. can we get a refund from philhealth for the meds that we bought outside the hospital for my baby and me?

    1. Hi umi, did you file your Philhealth papers at the hospital? If yes, you might be able to refund when you receive your benefit payment notice. If not, get claim and waiver documents from the hospital so you can file directly with Philhealth. Now direct filing is allowed if you bought meds/supplies outside.

  206. hello Pag-ibig, just want to ask if a pag-ibig member can use her card for CT Scan? Is it covered? Thanks, Jenny C. Que

    1. Hi Jenny, do you mean Pag-ibig or Philhealth? Sorry the Pag-ibig card cannot be used for medical deductions. Sorry the Philhealth card cannot be used to pay for outpatient CT scan.

  207. Hello! My mother went to hospital and had her doctor’s and specialist check up. Apparently, the specialist found out that she have a gal bladder problem that needed to removed as possible. She is an active PhilHealth member. We would like to know how much will PhilHealth covered for Cholecystectomy surgery. Is there any difference in your coverage for going to government hospital or private hospital? We live in Imus, Cavite and the closer hospitals that we have in here are St. Pillar Hospital and De La Salle Medical Center. Would you tell me what is our best option in this case. We have no enough money so we would like to clarify if do we have to pay a fee or the hospital bill before she leave? How much do you think would it cost for our part? Hope to hear a helpful information from you. Thank you very much!! Shirley F.

    1. Hi Shirley, the coverage for cholecystectomy is 31k (18,600 for hospital expense and 12,400 for PF). If private hospital, you need to talk with the surgeon about his PF and hospital cost, and how much you will pay if you use Philhealth. If government hospital, usually you buy meds and supplies outside (get ORs in your mother’s name so you can refund later on. File Philhealth before discharge.) and you need to ask the surgeon’s PF.

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