How to File a Claim for Philhealth Reimbursement or Refund

Update as of May 28, 2014:

You can NO longer file your claim for refund or reimbursement from Philhealth.

NO MORE DIRECT FILING WITH PHILHEALTH!

Submit your Philhealth documents to the hospital.  Submit documents on the day of admission so you will have time to remedy your papers if incomplete or not valid.

It is the hospital that will file your claim with Philhealth.  Your Philhealth coverage should be deducted from your hospital bill.

Make sure your Philhealth coverage has been deducted from your hospital bill before discharge.

If the hospital asks you to sign a waiver, read the waiver.  Do not sign any waiver that you do not understand.

Only members hospitalized abroad can file their claim directly with Philhealth.

 

Documents to submit to the hospital:

1.  Philhealth Claim Form 1  (original copy, filled-up and signed by you, and your employer if you’re employed)

2.  Updated and clear copy of Member Data Record (MDR) (Get this from Philhealth)

. If patient is a dependent, patient’s name should be written in the MDR as dependent.

If dependent’s name is not in the MDR, submit proof of dependency (birth certificate or         marriage certificate).  Some hospitals require you to update your MDR so that the          dependent’s name is in the MDR.

3.  Official Receipt of Philhealth premium payments (receipt showing payment for the required number of months)

. If employed, submit a Certificate of Premium Payments with OR numbers.

4.  Some hospitals require a Copy of Philhealth ID, or Philhealth card, or valid ID

5.  Authorization letter from Philhealth member, plus a copy of his or her ID, if not present to sign the Philhealth Claim Form 1

 

NOTES: 

After months of processing, you will receive a mailed or courier-delivered Benefit Payment Notice (BPN) from Philhealth. Philhealth will mail the benefit notice to the address you wrote in your claim form.

NOTE:  Merong additional required documents for confinements abroad. How to claim Philhealth reimbursement for hospitalization overseas How to Claim Philhealth Refunds or Reimbursements

412 Comments

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  1. hi, tanong ko lng po..mother ko po na confine sa hospital my PHIC po siya pero during sa confinement niya meron po kami na purchase na mga medicine sa hospital yung net na billing po (less PHIC) 6,700 tapos binawas po yung cash payment po nmin sa mga gamot worth almost 3,500 so yung binayaran po nmin almost 2700 nlng..Puede po bah ipa refund yung 3,500 na pinambili nmn ng gamot directly sa PHIC office?? pano po kaya yun???

    1. Hi jessica, dapat naibigay nio sa hospital ang mga receipts para naibawas nila sa Philhealth deduction. Isa lang dapat ang claim for each case, at sabi mo nga nagdeduct na sa hospital, so that means hospital na ang magke-claim. Or baka naubos na yong coverage, so hindi na kayo hiningian ng receipts ng mga meds na binili sa labas. Antayin nio na lang yong BPN from Philhealth and then kung meron pang kayong puedeng marefund sa hospital, get your refund from the hospital. Keep copies of your receipts.

      1. pwede p ba maka pag reimburse ng philhealth if june 1-4 2013 na confine un patient tpos ngaun lang magfafile ng reimbursement pwede p po ba un?
        sb kc s philhelt 14600 ung bnyad nila s hospital
        eh 13100 po ung binayad nmen less senior nging 10000 plus n lng po.bale if ever magkano po ung ma reimburse sna nmen po tnx po

        1. Hi cecil, do you mean kung puede pang magrefund sa hospital? Yes, puede pa. Dalhin nio yong benefit payment notice plus OR of your hospital payment (ixerox nio for your own copies) para makarefund kayo. Depende na sa hospital kung magkano irefund nila, kasi yong part of professional fee minsan ay hindi na nirerefund.

      2. Hi po ask ko lang po pwede po ba ma reimburse yung mga laboratory pinagawa sa labas o sa ibang hospital at mga gamot na binili sa ibang hospital at mercury drugs. Thanks po godbless

        1. Hi jena, it depends on the type of illness/treatment and hospital expense. If the fixed allotment for the illness is not spent fully by the hospital, you can refund part of your expenses later on. Keep your original ORs. Submit your Philhealth papers during hospitalization/before discharge, and present xerox of your ORs.

  2. hello po, tanong ko lang sana kung may makukuha ba akong refund sa ospital, ipinanganak ko yung bunso ko noong june2012. hindi kami binigyan ng bill sa hospital kasi daw wala kming babayaran.. CS po ako, nkatanggap na ako ng BPN pero hindi ko alam kung ano ang gagawin..2 BPN na ang natanggap ko.. please pkitulong nman.. sa government hospital po ako nanganak. salamat po!

    1. Hi mhar, do you mean you did not pay anything to the hospital? You cannot ask for refund from the hospital if you did not pay anything. You have no receipt to show for refund. All excess payments from Philhealth go to the hospital.

  3. WE ARE A HOSPITAL THAT IS LOCALLY FUNDED. KUNG SPONSORED MEMBER PO ANG PATIENT NAMIN AT NO BALANCE BILLING(NBB), .KAILANGAN PO BA NA ORIGINAL OFFICIAL RECEIPT PADIN ANG ATTACHMENT NG DOCUMENTS NAMIN, PAANO PO YUNG KAILANGAN DIN PO NAMIN I-SUBMIT ANG ORIGINAL O.R. SA AMING MUNICIPYO PARA PO SA LIQUIDATION NG PETTY CASH NG HOSPITAL

    1. Hi jona, one of those two (Philhealth or munisipyo) must accept certification and certified true copy of ORs, so that you can submit the actual ORs to the other one. I think it’s easier to talk with your munisipyo than Philhealth. Ask others too.
      I’ve read that Philhealth accepts Statement of Account from OFWs that can’t get ORs from hospitals abroad. So it might work with your case too, but you have to ask and confirm.

  4. Good afternoon po! I was admitted last Thursday (Feb. 15-16) sa The Medical City po. I have an HMO card. Nung sa billing na po, the HMO card covered all my expenses. Am I entitled for Philhealth reimbursement? Thank you.

    1. Hi Teia, do you mean your HMO paid even the Philhealth portion? If that is so, your HMO is a rare breed. Most HMOs do not pay the Philhealth portion. Did you submit Philhealth documents to the hospital? The hospital can submit the claim to Philhealth, and if approved, it’s your HMO that can ask for refund since they’re the ones that can present their payment receipt.

  5. Good Day,

    My daughter been in a certain Hospital due to Intussuception and undergone surgeon, confine from Dec. 30 2012 discharge on January 4 2013.

    My question is the Philhealth at the said Hospital deducted a certain amount on our billing upon discharge, but i had a few medical expenses (P 15,000.00+/came from my pocket) during confinement at Hospital, am i qualified at reimbursement?

    Pls. response..tnx and Godbless

    1. Hi Merwin, you can wait for the benefit payment notice from Philhealth; this will be sent to you via registered mail. If you see that Philhealth paid the hospital much more than what was deducted from your bill, you can ask for refund. Keep copies of your receipts.

  6. Hi po…ask lang po if pwede pa bang e apply yung philhealth claim namin for reinbursement kahit na more than 60 days nang discharge?mga 6 months na po..thanks

    1. Hi Abigail,sorry but your claim will be rejected, because the rule is it should be filed within 60 days from date of discharge. Ask others too.

  7. Good Afternoon po,

    I just want to know the status of my claims.. My wife admitted in the hospital last Dec 15, 2012. I already submitted the necessary requirements to Philhealth at Diosdado Hospital.The Philhealth officer told me to call on this # 441-7442. I tried to call this # several times but the operator said that I entered the wrong format of admission date. May I know the reason why? or maybe there some kind of a problem in the machine?

    1. Hi Ramon, based on those commenting here, it takes about 2 to 4 months for Philhealth to process claims, which is an improvement over the 4- to 12-month processing time before. Did you enter 12152012? If yes, and the phone says invalid, then yes, the phone has a problem. You should receive a benefit payment notice from Philhealth via registered mail after your claim has been processed.

    1. Hi Victor, sorry, but that’s the rule. It’s on the forms. It’s on the Philheath website. That is one of the most common reasons claims are rejected or denied.

  8. hi, i’m quite confused, i was admitted last Dec 28 – 31, had to pay 5,000 something for my Philhealth portion..rest of the hospital bill covered by my insurance at the company I work for. I hadnt had time to take care of the documents since Im living alone and nobody went wth me when I was admitted and maybe am too proud to ask for help from my busy friends. My Q is that, I started to work for the company Nov 12 that same year, am I still quailified to file for a reimbursement? I really am quite confused coz I just had paid 3 monthly premiums before I was confined and that’s what I see in the PHIC website. the lady at the billing sec of the hosp also told me to claim it a month after I got dicharged.. am I eligible to be refunded of the Philhealth portion that I paid?

    1. Hi dewdrops, you have less than 48 hours to file a claim. Filing should be within 60 days after discharge. But wait, did you mean you started paying Philhealth only last Nov 2012? If yes, I think you’re not yet eligible. For employed members, the requirement is that one must have paid 3 of the 6 months PRIOR to month of confinement. Ask others too. By the way, I hope you can find later on at least one friend whom you can ask one favor. I was like that when I was younger. I was too considerate; I don’t like to disturb anyone. I was independent, so I expected everyone to be independent. I found out later that there are people who like to help.

  9. .gudaftrnun po,.im resty,ask q lng poh! ung asawa q nanganak last june 21,2012 but till now wla pa ung BPN na sinasbi po nila,.but before mdischarge ung mrs. Ko,naisubmit q ung mga docs.n pnpaacomplish skn,.

    1. Hi resty, did the hospital deduct your Philhealth benefits? If yes, that means, they saw that you’re eligible. But if they did not, there could be a problem. Visit the nearest Philhealth with your ID, and ask about your claim.

      1. no mam,.kasi knuha nla skin or pnpasa nla skn ung mga RESIBO.out of stock dw kc cla ng mga gamot..sbi xkn nung staff 3 to 6 mos dw bgo q mku2ha ung refund,bt till nw wla p po ung Bpn.im frm zambales san po me pwd kumuha ng bpn,f ever.

        1. dineduct po nla ung mga hospital bills po mam,.maliban xa mga gamot kasi s labas po ng hospital aq bumili ng gamot,wla daw clang stocks,.kaya aftr kami umalis pnaiwan xkn ung mga resibo ng mga gamot n bnili q,.

        2. Hello sir! same case po tyo .. june 2012 pa po ako nanganak via cs til now wala prin po BPN .. yung sa gamot din po na nabili nmin sa labas ang hnihintay namin na marefund.. Yung sa inyo po ba nkuha nyo na ngayon or may BPN na po dmting sa inyo? Thanks po ..

  10. ask ko lng po yung about za checked my dumting po kasai sa aking checked march 01 2013 den when i saw it its only valid on that day also paano ko po maiiclaim yun kung kahapon ko lng po ntanggap late po kasi sya dumating via post office thank you po

    1. Hi madelaine, I’m puzzled you said “valid on that day”. Did you mean the date on the check was more than 6 months ago? If the check was issued more than 6 months ago, you can go to Philhealth and request for reissuance.

  11. mam.gudam poh,mam base po dun xa tnawagan q s custumer service ng philhealth,ok npo ung status ng checke availble n poh,but ung bpn n hnhtay namin eh wla p,pwd bng kunin q nlang s hospital ung refund kht wla ng bpn..8months npo kc eh..im frm zambales poh.

  12. gud day poh, ask ko lng po pwdi n po b aq magclaim kht la p ung BPN kc po m0re dan 8m0s nq waiting ng bpn but til n0w wla p,but ung cheke daw ay available n.G0d bless poh ty

    1. Hi racel, that would depend on the hospital. Try to ask the hospital for your refund. Bring your hospital receipt (xerox and orig). You can also ask your postman or post office to check their records. Philhealth mail is recorded because it is registered mail.

  13. Regarding po sa filing beyond 60 days, ask k lang kung wala na po bang consideration? o mag appeal for consideration? thanks

  14. hi im Aiza last year December 10 to 12 n confine ang anak q at nung December 28 ska lng na file ng sister q ung requirements and they said 2 months rocessing daw and last week march 2,2013 i follow-up my claims if meron na the CSR said that our reimbursment claims was denied…so i was confused why?and they said late filing dahil ang naka record sa kanila ng date of confinement October 10 to 12, 2012. i ask what should i do ung staff nyo nagkamali ng type ng date of confinement.kc sa slip nmn n binigay samen is DEc.10 – 12 ,2013 ang confinement.so panu dapt ba mag antay n nmn aq ng another month?.e supose to be meron n dapat…tnx

    1. Hi Aiza, sad to say, even if it’s their fault, your papers have to undergo another processing, beginning with initial evaluation, etc., so you have to wait for 2 or 3 months again. It’s frustrating because these employees who make mistakes do not have the power to correct their mistakes in a way that you can get your check immediately. They’ll still process your papers through the same procedures.

  15. Gud Eve PO mam ma itanong ko PO mam Kung may refund BA among sa baby’s bill ko nanganak naku last Nov.29,2912.ako PO mask ang nag bayad engaged baby’s bill ko PO mam.thank you po

    1. Hi almacelocia, did you give 2 claim forms to the hospital? one for you and one for your baby? If yes, then wait for the BPN from Philhealth.

  16. hi po, naoperahan po ako non March 1, covered naman po ng HMO ang lahat except Philhealth, nakapag file na din po ako sa hospital lahat ng requirements para sa Philhealth.. outpatient po ako kaya yong mga nabili kong gamot hindi na kasama sa bill, tanong ko lang po kung pwede ko pa ma-reimburse yong mga nabili kong mga gamot? pano po ang gawin ko? thanks

    1. Hi Honey, sorry but Philhealth covers only medicines used during the operation. I think even your HMO has the same policy, but you can ask your HMO if they have special considerations. Ask others too.

  17. gud day, matagal na din po ako naghuhulog sa philhealth since 2000, pero nahinto po ako magtrabaho since 2006 after po nun hindi na ako nakapaghulog, sa ngayon po nasa ospital ang father ko mayroon po ba ako maaasahan? o kung ano po ba pwede gawin para magamit ko pa sa father ko? 63years old na po sya..tnx

    1. Hi nel, it’s sad, but Philhealth runs a hospitalization insurance that needs updated payments. You can only use your Philhealth if you have paid at least 9 of the past 12 months. Senior citizens get 20% discount for medicines if they have senior citizen IDs.

  18. hi good afternoon po, panu po process pag gusto ko na ireimburse sa PHIC ung bill ko sa hospital ayoko po kasi na hospital ang magkaltas sken ng PHIC ko eh, anu po sasabihin ko sa hospital if gusto sa PHIC mismo mag reimburse? anu po mga kailangang documents? at anu po yung mga documents na manggagaling sa hospital?
    thank you po

    1. Hi joy, just tell them that you will use Philhealth, but that you will be the one to file directly at Philhealth. Just make sure that the claim forms are signed by the hospital and doctor before you are discharged, so you don’t need to go back. The documents are listed in the article above.

  19. hello po gud pm,, ask ko lng po sana kung pwde ko pa mpareimburse yong doctor’s pf..pero noong october last year pa ako na admit ngaun ko lng na receive yong BPN..ang na deduct lamang skin eh 6500 ng hospital pero nakalagy dito sa bpn na 11k binayad ng philhealth..need somw advice, thank you..

    1. Hi isabel, yes, you go to the hospital with your BPN and OR of your payment to the hospital (keep your xerox copies), and ask for refund. If they ask, tell them you received your BPN only now.

  20. please give me some advise maam…i was confined last year october..can i still refund my doctor’s PF? kasi ngayon lng dumating yong BSN ko..please need some advise thank you..

  21. Im mon.. Tanung ko lang poh sana, nanganak ang g.f ko at ako ang father, i am a gov employee phlhealth member dn yung puh bang anak ko pwd sa claims kasi nkasunod naman sa apelyido ko? Pls reply..

    1. Hi reymon, yes, your child is your dependent. Update your MDR with your child’s birth certificate. But you can use it only for the newborn package claim of up to 1750 (if they did all the procedures). You cannot use it for the maternity claim.

  22. Hi,
    I gave birth in a public hospital via C-Section. I submitted the OR of the medicines used for the operation to the Philhealth office of that hospital. I believe I will get a reimbursement check for the medicines I bought. Am I right? Thank you.

    1. Hi joby, yes, if your total hospital cost has not exceeded 11,400. The 19k coverage for CS is divided into 11,400 for hospital cost and 7,600 for doctors’ fees.

  23. Hi!! nanganak po ang aking asawa gumastos po kami ng P6500 sa gamot halos lahat sa labas ng ospital namin nabili.. tanong ko lang po sana kong hangang ilang percent ang pdeng ma refund namin sa PhilHealth..

    1. Hi chano, what’s the level of this hospital? If it’s level 1, you can refund 3900. If it’s level 2 to 4, you can refund 3k. If you paid the doctors’ PF, you can refund additional 2600 (level 1) or 2k (level 2 to 4). Keep copies of your receipts

  24. Hi! I’m a Philhealth member for almost 7 years now and I have my father(64 years old) as my dependent. He is also my dependent in a private HMO. My question is, if he will undergo a cataract operation, how much (percentage) will be shouldered by Philhealth and how much will be shouldered by my HMO? Is it 50%-50%? 80%-20%? 60%-40% or what? I know that the Cataract package of Philhealth is Php16k and my HMO can cover up to Php60k for cataract operation. Thanks!

    1. Hi Ross, your HMO will pay whatever Philhealth will not pay, up to 60k, as you mentioned. For example, if the total cost is 70k, Philhealth will pay 16k and your HMO will pay 54k. If it costs 80k, Philhealth will pay 16k, your HMO pays 60k and you’ll pay 4k. There are rules by which Philhealth pays 16k for each eye (32k for 2 eyes), and Philhealth requires preapproval for cataract operation (after April 2013), so you must talk about these with your doctor.

  25. Hi, I’m Gerry. Is it possible or qualified to reimburse CT scan receipt even if the patient was not confined. My son was discharge from the emergency room right after mabasa ng doktor ang resulta ng CT scan.

    1. Hi Gerardo, sorry, I think it’s not covered because CT scan is a diagnostic procedure. I think this is only covered if it’s performed during confinement. But to be sure, ask others too, or Philhealth.
      The outpatient procedures covered are day surgeries, cataract removal, radiotherapy and hemodialysis.

  26. Hi,
    mayroon akung ipa confirm sa inyu asawa ko na discharged January 14, 2013 sa vicente sotto hospital sa cebu tanung kulang kailan matangap ko ang refund sa mga medicine at laboratory sa cityscan yung lahat nang mga original reciept na ibinigay ko sa hospital.

    1. Hi Romil, wait for the benefit notice from Philhealth. Will be delivered to you by registered mail. Xerox this notice and then ask for your refund. It takes about 2 to 3 months for the notice to get delivered. There are times it can take more months.

  27. ask lng po. my sister n law gave birth,january 27..6months. contribution. will d expeenses for d baby b eligible for a refund? we all have d requirements except d birth certificate,kasi d cla kasal and sa ibang bansa yong father.pwde po to follow n lng? nae send na po ung birth cert kso lng baka d umabot xa 60 na procesing period for d claim.thanks

    1. Hi monette, is your sister in law a voluntary member? She needs to have paid Philhealth for 9 of the 12 months BEFORE January. If she paid only 6 months, she’s not eligible for benefit. If she’s OFW, she can qualify if her date of delivery is within her receipt’s validity dates.

  28. last December 28,2012 my son was confined sa specialist group trauma hospital in Dagupan City and since holiday sa company namin i choosed to pay the philhealth charged around 9k kasi asthma diagnosis sa anak ko. Then my mother filed reimbursement on my behalf in Philhealth Dagupan City last January 15, 2013 and until now no refund yet and i keep on calling the philhealth number ayon puro music naririnig ko and no one answered my call.

    1. Hi Janice, I don’t know if Philhealth processing time has really improved, but it’s less than 3 months after your mom’s filing. Some people here commenting say they waited for about 5 months or more, although there are those whose cases were processed for about 3 months only. Your mom can visit the Dagupan branch and inquire if this is near her place.

  29. follow up po itong tanong ko. Bukod po sa doctors fee under philhealth ai siningil kami ng extra 12thousand pesos ng doctor at hindi po kami naibigyan ng resibo, pwede pa po ba ito mairefund dahil bukod sa gamot na ibinili namin ay may excess pa rin?

    1. Hi Estelita, do you mean the doctor asked for money directly from you and you gave the money directly to the doctor? Because if you pay to the cashier, there’s always a receipt.

  30. Hi yung Maternity Clinic ko is Philhealth Accredited pero nung nag ask ako about NSD Painless hindi na daw pwede i autocharge sa kanila kasi yung ina allow lang nila yung NSD without anesthesia, pwede ko ba i reimburse yun sa Philhealth by my own?

    1. Hi ellababy, yes, you can file directly with Philhealth, but ask your maternity clinic if they can accomplish all the claim forms before you are discharged. Include your prenatal ORs so you can refund your prenatal expenses.

  31. hi po na confine ung anak q last jan.31 this year ang hsptal bill nmin ay umabot ng 4800 wla kming nbayran khit piso kc po nbwas lhat s phlhealth ng mr.q ask q lang po kung my m refund p kmi pero my ngstos kmi s mga gmot bili nmin lhat nka attach un s mga papeles n sinubmit nmin s hsptal. f meron po kming m refund kelan po kya nmin mkuha un?

    1. Hi lyn, wait for the benefit payment notice from Philhealth via registered mail. If Philhealth’s payment to the hospital is higher than 4800, then go to the hospital with your notice for refund. Keep a copy of your notice.

  32. Good day ho.OFW ho ang asawa ko at dependent niya ako.naadmit ho ako sa government hospital due to pre-term labor. Binawasan po ng hospital ng 7000 ang bill ko. mayroon ho akong receipt amounting 2600 na nagastos ko ho sa gamot. Itatanong ko ho sana kung pwede ko pa ireimburse ang mga nagatos ko sa gamot at magamit uli ang philhealth kapag nanganak na ho ako.

    1. Hi franschette, yes, you can use again your Philhealth as long as your husband is updated with his premium payments. For normal delivery, coverage is up to 4. About the refund, wait for your benefit payment notice from Philhealth (registered mail), and if you see that Philhealth paid the hospital more than 7k for hospital costs (except PF), ask for refund, up to 2600 or up to the excess payment (if excess is less than 2600).

  33. Hi. I have a problem also.

    We were discharged without having to pay any excess since we’re under NBB. But we’ve collected receipts for meds used during my CS operation amounting to around 7000php. We’d like to ask for the refund and we attached meds receipts to the hospital together with the claim form. We bought these meds and stuff because hospital doesnt have stocks and they said it will be reimbursed anyway if we’ll just keep the receipts.

    I received a BPN just now and it indicates benefit paid to the hospital and doctor- 1550. It doesn;t say anything about amount that they’ll refund for the meds we bought.

    Does BPN also indicate your refund, say 7000+ worth of meds spent from your pocket related to the surgery or is BPN just a statement of how much they paid to the hospital?

    I’m afraid that they might have missed the original OR for meds that we submitted and we might not receive refund. We don’t have OR copies since hospital staff said it’s ok not to keep copies,

    1. Hi Grace, I’m puzzled why Philhealth did not pay the hospital 19k, which is the coverage for CS. You can bring your BPN to Philhealth and ask. There might be rules/developments about NBB that I have not encountered. I checked some NBB circulars and I can’t see why they paid only 1550. Because if Philhealth paid 19k, then you can go to the hospital and ask for your 7+ refund. best regards

  34. hello po, bale na D&C po ako last march 31, 2013 sa st. luke’s global city, ngayon po nasa akin po lahat ang requirements bago kami madischarge kaya lang po that day wala po yung doctor kaya hindi po niya na fill upan yung form na dapat ay sa kanya sa ngayon po nakailang balik napo ako sa st. luke’s para lang po sa sign ng doctor, ang tanong ko po in case po ba sila napo ang dapat mag submit or ako po?? kasi po sila po yung inintay ko para mai submit ko na po sana… tsaka po mam ilang percent po ba ang marerefund po namin kung ang bills na binayaran ko po ay nasa 70k??? wala pa po don yung mga check up ko, like ultrasounds at ibang lab test, meron po ba akong marerefund kung saka sakali po sa mga check up ko??? salamat po sa reply in advance po.

    1. Hi Carla, D&C is under the case rate scheme, meaning the coverage amounts are fixed, regardless of whether it’s in an expensive hospital or in a cheaper hospital. Coverage for D&C is only 11k (6600 for hospital expenses and 4400 for PF). About filing, ask their Philhealth department if their next filing schedule is the current day or next days, so you can submit it through them. But if it’s weeks away, then submit your claim yourself directly to Philheath. Just make sure all your documents are complete.

  35. gud pm…. naospital ang mother namin may 2012 and namatay sa hospital ng june 3.. ng file kaming refund sa philhealth nag submit ng mga hinanap na documents.. tinanggap nila and we waited for 4 months only to received a mail na may kulang daw .. OR NG HOSPITA AT PF NG DOCTOR.. so nilakad namin yon at submit ulit.. ok na daw kumpleto na .. maghintay nalng daw kami after 2 months .. so nag hintay kaming halos 3 months para maka received na naman ng letter hinanahap na naman ung birth certificate ng nanay namin.. wla syang birth certicate pero nag submit nakmi ng marriage at death certificate nya… well kung kailangan talaga ng mga documents na yan bakit bakit sa first filing pa lng di nila hinanap yan at nung second filing namin ok na daw after 3 months sasabihin may kulang na naman wala ba kayo ways para inform mga members na hindi na kelangang mag wait ng ilang buwan bago malaman ang problema..
    ive read na marriage cert is valid in absence of birth kumpleto ung pinasa namin bakit hinahanapan pa kami ng birth.. what if hindi namin ma produce ung birth mababalewala ung claims namin.. and besides din namin kasalanan kung may kulang anong klaseng sistema ung ginagawa ng mga tauhan ng PHILHEALTH… bakit pahirap sa paying members ang mag claim ng benefits …

    1. Hi Gloria, yes, you’re right, the Philhealth officer should have checked your papers before accepting them. Or they should have a list of requirements there posted in their office for all members to see.
      The Philhealth website lists the required documents.
      By the way, I’m not an employee of Philhealth, I just write about Philhealth.
      I’m surprised that the Philhealth officer did not see that there’s no hospital OR — this is a basic requirement. I suggest you write your complaint here so Philhealth people will see: facebook.com/PhilHealth or email info@philhealth.gov.ph or actioncenter@philhealth.gov.ph

  36. gud pm…. naospital ang mother namin may 2012 and namatay sa hospital ng june 3.. ng file kaming refund sa philhealth nag submit ng mga hinanap na documents.. tinanggap nila and we waited for 4 months only to received a mail na may kulang daw .. OR NG HOSPITA AT PF NG DOCTOR.. so nilakad namin yon at submit ulit.. ok na daw kumpleto na .. maghintay nalng daw kami after 2 months .. so nag hintay kaming halos 3 months para maka received na naman ng letter hinanahap na naman ung birth certificate ng nanay namin.. wla syang birth certicate pero nag submit nakmi ng marriage at death certificate nya… well kung kailangan talaga ng mga documents na yan bakit bakit sa first filing pa lng di nila hinanap yan at nung second filing namin ok na daw after 3 months sasabihin may kulang na naman wala ba kayo ways para inform mga members na hindi na kelangang mag wait ng ilang buwan bago malaman ang problema..
    ive read na marriage cert is valid in absence of birth kumpleto ung pinasa namin bakit hinahanapan pa kami ng birth.. what if hindi namin ma produce ung birth mababalewala ung claims namin.. and besides din namin kasalanan kung may kulang anong klaseng sistema ung ginagawa ng mga tauhan ng PHILHEALTH…

  37. hi! my son was hospitalized last january and we used his father’s Philhealth (my fiance). The hospital was not able to deduct the necessary deductions because they needed a total of 6 mos contribution and my fiance only has 4 so we were told to directly file it to Philhealth. I completed the documents and submitted it and was advised to wait for 60 days. I did. I called after 60 days and was told that the claim was denied due to 1.CASE NOT COMPENSABLE 2. 45 DAYS PER MEMBER PER HOSPITAL POLICY IN EFFECT.
    The hospital and my son’s pedia clearly stated that we will get a reimbursement of 15k (for pneumonia moderate risk diagnosis). A doctor friend told me that the xray did not match the doctor’s diagnosis so it is clearly the fault of the doctor. What am I supposed to do? Pls advise. Thank you.

    1. Hi Lyn, the doctor and the hospital should not have assured you that it will be covered by Philhealth if they were not sure. Or they could have told you that low-risk pneumonia is not covered. If the doctor was in doubt about the severity, about whether to have your child confined or not, or medicated at home, she could have explained to you the situation and allowed you to choose, or sign a waiver. You can email Philhealth actioncenter@philhealth.gov.ph. Or you can go to the hospital with your Philhealth notice and your payment receipt (keep copies for yourself) and ask the hospital/doctor to refund you part of your payment since they erred in their initial diagnosis.

      1. Hi ma’am!nanganak aq thru cs s ospital ng manila last jan8,2014 at nadischarge kmi ng baby q jan 17. Inaattached q po lahat receipts ng medicines at laboratories nagtotal ng 19k+ s form ng philhealth n submit q s billing section.since govt hosp xa at d aq tga manila eh kmi po buy gmot s labas hosp at laboratory pati new born screening kmi nagbayad.nun lumabas n kmi la pinakita billing s amin basta tell ng staff s billing n nka package aq ng 19k tpos since member ng philhealth la n kmi binayaran..sbi nla after 2-3 mos mkkreceive aq notification fr philhealth..sad to say aq n ngpunta s last june 20 s branch nyo s cloocan to get the bnp..den xol aq s hosptl sbi for pickup n check q.nkuha q po un check nagaamount ng P 3041 po..y po gnun lng nareimburse s akin? S sama ng loob q d q p po encash un check kc pno q un ipnbayad s utang sobra kulang po un..plz help me..tnx po

        1. Hi jazz, the coverage for CS is 19k (11,400 for hospital expenses and 7600 for doctors fees). Maybe hospital expenses amounted to 8386 so you got only 3041. Or some of your receipts were not ORs. Ask your hospital.

  38. Hi Ask ko lang i was hospitalize last Jan 2013, nareceive ko na ang BPN ko yesterday pero nagulat ako sa laki ng payment made sa Hospital at sa DR.. kaso ang nakalagay sa note ng BPN actual charges not accomplished, so meaning wala ako refund or check in return, pero nkkapagtaka lang po is almost 5k lang ang nakaless sa billing ko at the time of discharge at nkalagay sa BPN ko 11k ang total amount paid nila.. pls help pano ko po makuha ang right amount para sakin..

    1. Hi Jeng, is this D&C or raspa? 11k for raspa is further allocated as 6,600 for the hospital and 4400 for the doctor. Go to the hospital with your BPN and hospital bill payment receipt (xerox them so you have copies) and ask for refund of the rest of the amount that you paid.

  39. good day!

    nakuha ko ung benefit payment notice at nakalagay dun eh P38 thousand pero nung makuha namin ung tseke sa ospital eh P14 thou na lang.

    1. Hi ice, is this CVA 2? 22,800 is for hospital costs and 15,200 for the doctors. If you paid the hospital more than 14k, xerox your bpn and hospital bill receipt and ask the hospital for a refund of the amount you paid.

  40. Hello, I just wanna ask regarding my case. I was admitted due to bleeding (blighted ovum) It somehow called miscarriage, but theres no baby, only sac.. Here’s the thing, I was admitted for D/C, but because i stopped bleeding theres no operation was done. Still I stayed 2nights in the hospital and continue my oral medication so that the remaining tissue will go out on its own like a mentruation. Just when we completed the requirements and we pass it the to the philhealth hospital for the reimbursement, they ask for OR (operation record) which i do not have cz no operation was made, then my OB wrote in the CF2 in the ‘Final Diagnosis’ – Incomplete Abortion. So then the staff in the hospital told me they cannot process the paper because of the final diagnosis. I am still in the care of my private doctor,in her clinic not in the hospital i was admitted. So my question is,they cannot reimburse our hospitla bill because of what my doctor wrote in the final diagnosis.,is it really relevant? or is there anything we can do?

    1. Hi Ayee, yes, the final diagnosis is important because they’re going to write a Code for your illness/treatment. No code, no Philhealth coverage. Is your doctor’s private clinic Philhealth-accredited? Because you can file your Philhealth claim as a patient there, as a transfer case. But if not, you can ask your doctor what she can write on the final diagnosis so you can claim your Philhealth. How about Abortion? But I have doubts because the treatment was not completed there. But you can ask your doctor.

  41. hi! i have a question with regards to reimbursement of medicine costs.. my father is the member of philhealth and his beneficiary is his father. but some of the receipts have their name mispelled like my father’s surname starts with a B, but with some of the receipts, it started with V. would it cause a problem with filing the reimbursement? what actions should be done? do they need to ask for new receipts with correct spelling of their names? thanks a lot in advance.

    1. Hi marvi, were these medicines bought while your grandpa was in the hospital and were used during hospitalization? It should have been your grandpa’s name that was written in the receipts because he’s the one using the medicines. Wasn’t his name written on the prescription slips? If you can, have the receipts corrected or changed. But ask the hospital also about their policy.

  42. hi! my baby was hospitalize last dec 2012 our bill almost 200k including the hospital bill the medicine laboratory and the doctors fee. but when i receive the check from my refund wala pa sa 1/4 ng bill ang narecieve ko 48k lang. tama po ba kaya ang computation nila. thanks

  43. Hi, my Dad has twice a week dialysis at St. Paul’s Hospital in Tacloban. But prior to that he had his dialysis in Manila (Manila Docs) and we got hte philiealth privileges. Now i am surprised that even if St. Paul’s Hospital is a Philhealth affilliated Hospital, they do not accept the applications and suggest that we just had it reimbursed. Is it there option to sy that to the patients especially that dialysisi is very expensive. Not all, if not almost all patients cannot afford any dialysis treatment and they are making it hard for the people by not accepting any applications and wait for reimbursement instead. Is there a number I can call to ask about this? Thank you and the blogs have been very helpful.

  44. Good day. I gave birth last April 16, 2013, c-section. My HMO, covered the 80% of the total bill and I will pay the 20% thru salary deduction. My question is, can I ask a claim for this case? The receipts will be given to our HMO who paid in advance the whole amount. Also, the last contribution I paid is last October 2012 (I got employed with an international company which staff pay they contribution individually. Thank you for your help.

    1. Hi Arlyn, I’m puzzled why you did not submit your Philhealth documents so that the 19k coverage was deducted immediately from the bill. Did your current emnployer pay your Philhealth contributions for at least 3 of the 6-month period from Oct 2012 to Mar 2013? Are your doctors and hospital Philhealth accredited? If yes to both questions, then you can file your maternity claim with Philhealth.

  45. To continue, my husband is also a philhealth member who is updated with his contribution. Thank you

    1. Hi Arlyn, do you mean your current employer has not paid your Philhealth? Are you newly hired by this employer? If so, you need to file as a dependent of your husband. If Philhealth asks, you need to be able to explain why you should be a dependent when you are currently employed? Philhealth’s rule is that one cannot be a dependent and at the same time an active member.

      1. Yes, I was hired last October 2012. International company kc ito new employer ko like an embassy kaya we pay our own sss, philhealth and pagibig. It will be my husband na po ang mag file? Last question po, if my HMO paid for my hospital bill (I have a share sa bill which will be deducted in my salary), what is the process for that? On my own processing po ba ito or the hospital can help me even I am already discharged? Thank you very much :D

        1. Hi Arlyn, you or your husband can file your claim at Philhealth within 60 days after discharge. Documents are listed above. Request for the accomplished claim forms from the hospital. Since you say you’re an Individual Payor… and if you have not paid 9 of the 12 months BEFORE month of April (requirement for Individual Payor, maternity case), then you will have to use your husband’s Philhealth. Ask your husband to update his Philhealth record so he can register you as his dependent (needed are your marriage certificate, his ID and your letter requesting Philhealth to cancel your membership and to register you as a dependent of your husband). Ask others too; I might have missed some things.

  46. Ask ko lang Kung outpatient impacted tooth dental surgery for next week, what do I need to do? May mababawas ba sa 10,000 na hinihingi sa akin ng doctor for the pf

    1. Hi Tin, first, ask your dentist if he/she is Philhealth accredited and his/her clinic is accredited. The dentist is the one who will fill up the claim forms, so he/she should know.

  47. Hi! I have these clarifications of mine, hoping for your answers:
    1. I was confined (undergo D&C) last Jan 28-29, 2013 at a govt. hospital and paid nothing upon discharge. However, we bought medicines outside of the hospital worth ~2k. Until now, I am still waiting for the notice ’cause as per, I need to wait for the notice for me to file for reimbursement (i kept all the receipts). I’m just worried ’cause it’s already beyond 60days. Can I still process for reimbursements for case like this?

    2. Ilang months po ang needed para maka-avail ng benefit? If magpamember this month as Voluntary member, when po pwedeng maka-avail ng benefit?

    Thanks and God Bless!

    1. Hi Gracia, did you submit Philhealth documents to the hospital? If the hospital said something about waiting for the benefit payment notice (BPN), it means that the hospital has already filed your claim for you, and this means also that you need not worry about the 60-day deadline. After receiving the BPN, you go to the hospital with your receipts and request for refund.
      For voluntary members, they can start using Philhealth after 3 months for ordinary and non-surgery illnesses. For maternity and surgery cases, they can use it after 9 months of payment. God bless too

  48. ask ko lang po nasa hospital po today ang ate ko na nanganak last tuesday may 21, 2013, karamihan po na iniresetang gamot sa ate ko ay sa labas po nila binili kasi po walang stock daw po ang pharmacy ng hospital sa loob my question is marereimburse ba ng ate ko yung lahat ng gamot na binili niya sa labas at ask ko na din po hindi rin po nakagamit ng philhealth room ang ate dun mismo sa hospital kung saan siya nanganak ang reason ng hospital may reservation daw ang philheath room nila, pwede po ba yung ganun? diba dapat once na naconfined ka if you a philhealth member your are qualified to use the philhealth room, then today discharge niya na po sa hospital biglang sasabihin ng hospital may hospital bill kaming babayaran pero even may ate’s confinement hindi naman siya nakagamit ng philhealth room at true po bang 3k lang ang covered ni philhealth for maternity package. pls help naman po. thanks and God bless

    1. Hi Jennifer, yes, at bigger hospitals (level 2 to 4), the maternity benefit is only 5k (3k for hospital and 2k for PF). Your sis must have delivered at a government hospital because, as you said, you bought supplies outside. If the hospital deducts 3k from your hospital bill and 2k from PF, then you can no longer refund your expense for supplies bought outside because the 5k coverage is already used up, or already claimed via deduction.

  49. hi po ask ko lang po kasi na na discharge po un father ko nun september 24, 2012. nag submit kami ng philheath claim kasama un mga resibo sa taguig-pateros district hospital for refund ng gamot at ct scan nun october 15, 2012. at hanggang ngayon ay wala pa dumarating na BPN sa amin. saan po ba pwede i follow up un? pwede po kaya kunin nlang un sa philhealth office mismo? thanks.

  50. after one year my employer file my Philhealth benefits after series of follow up before,during and after giving birth of my wife last May 25, 2012.

    Is this applicable up to now. then Do I need to file directly or still my employer. All the requirement submitted to my employer. The problem encounter when my employer ….

    1. no certification of philhealth contribution to submitted as per them the issue was transition of the name company to another company.
    2. My MDR not reflect as employed status due to transition issue.
    3. my employer not smoothly updated regarding this transaction.

    I’m employed as room attendant with direct and indirect hired.

    1. Hi Alex, sorry there’s a deadline for filing a Philhealth claim. File within 60 days after discharge. So kung hindi naka-file around July 25, 2012, hindi na puedeng mag-file.

  51. hi, nnganak po ako nov 30 c-section, sa govermrnt hospital po ako nanganak. ng charity lng po ako, pero madmi po ako nabili gamot sa labas lahat po ng gamit s cs. bumili p po ako ng 2 bags n blood. my dumating po 2 notice n bpn, pero wala po check my refund po ba ako. liebel

    1. Hi leslie, did Philhealth pay 19k to the hospital? If yes, you can ask your refund from the hospital. Bring your notice and receipts. Keep xerox copies.

  52. helo maam,.ofw po ako.member po aq ng phil health.ngayon nsa ospital po ang asawa q.yung pag reimburse po b kasali po b yung mga gamot na binili sa labas kc po out of stock dw.po s loob ng ospital.mareimburse din ba mga yun???

    1. Hi anne, ask the hospital kung isa-submit sa kanila ang receipts para masama sa deduction. Keep copies of these receipts for yourself. Kung hindi naman, kasi depende kung under Case Rate or Fee-for-service ang sakit, wait for the benefit payment notice from Philhealth, and then kapag higher amount ang ibinayad ng Philhealth sa hospital kesa deduction ninyo, you can ask for refund from the hospital. Keep a copy of your notice.

  53. hi po i was diagnos with incomplete abortion sa st claire and since wala n kme pang byd sa d ans c procedure dhil we had 39000 bill aside vfrom the d and c procedure n gagawin pa skin kaya lumipt kme sa isang maliit n private clinic at hindi xa philhealth accreditted since emergency n kaya khit gnun dun n lng ako ngparaspa. my question pede po b mareimburse yun another 14ooo n binaydn namin dun s clinic khit hindi xa philhealth accredited?

    1. Hi melisa, sabi ng Philhealth kelangang Philhealth accredited. Yong sa St Claire na lang ang subukan niyong i-file; although I’m not sure kung anong i-file kasi hindi nila na-perform yong D & C. Dapat tulungan kayong mag-file kasi nagbayad kayo ng 39k.

  54. Hi,

    My mother has been admitted last July 4. She is 55 years old;hence, i cannot yet declare her as my dependent (please correct me if i’m wrong). Due to fincial difficulties, i did my best to rush her membership the next day – July 5. I even paid her dues in advance. However, we were informed that Philhealth cannot yet shoulder the corresponding anmount, since she’s just a new member. Is this true? Is there any other way for us to reimburse her expenses throught Philhealth? Please we really need your advise on this. Thank you very much!

    1. Hi Hyzl, sad to say, you cannot immediately use Philhealth. If Individual Payor, you can use it only after 3 months (for common illnesses) or after 9 months (for surgery and other complicated diseases). Kapag malaki ang bill, at nasa hospital pa, puede kang lumapit sa PCSO desk office ng hospital.

  55. na hospital po ang mother ng friend ko sa tondo general hospital at sa caloocan po sya ng file ng philhealth nya. nakarecib po sya ngayon ng call from tondo na dumating na dw ung refund from philhealth… ang problema po kasi dito na sa cebu nakatira/nakabase ung friend ko. is there any possibility na ma transfer sa cebu branch ung cheque nya from manila? please advise po kng ano dapat gawin to claim the cheque.
    salamat

    1. Hi isabel, that would depend on the policy of the hospital. You can ask Tondo hospital if you can claim the cheque using an authorization letter from your friend plus IDs.

  56. Hi, po, nagsubmit ako ng reimbursement sa may hospital sa Meycauayan Bulacan , back in April 24 2013 and still have not received any notification, san ko po ito pwede ifollow up? I am working in Boni Mandaluyong, pag nagpunta po ba ako sa office kung saan nagsusubmit ang office namin makikita po ba nila yung status ng claim? kasi po kung Meycauayan ito baka mga bandang Malolos po ito na submit ng hospital, machecheck po ba ang status on line worry ko po baka kasi denied eh

    1. Hi Maricar, yes, puede nilang ma-check basta na-encode na ang claim mo sa Philhealth system. Merong mga claims na 4 to 5 or more months pa ring ang processing.

  57. hello mam. nkatanggap po kmi ng cheque mula sa philhealth. kaya lng ang nakapangalan po sa cheque ay namatayb na po. ang tanong ko po paano po namin kaya ma encash ung cheque. patay na po ung may ari ng cheque.paano po kaya iyon?

    1. Hi gerry, usually what is done is that the principal beneficiary (spouse or children) writes a letter to Philhealth asking for a replacement check. Attach birth certificate or marriage cert and check. Go to Philhealth and ask for further info. Keep a copy of the check.

  58. Hi,
    Nakatanggap po ako ng benefit payment notice today
    meaning po ba nito ok na yung claim nmin for reimbursement or meron pa silang hihingin na docs? Nwawala na po kasi yung mga resibo since yung confinement ng father ko was Sept. 2012 pa.

    1. Hi Cha, depende na sa hospital, pero usually hinihingi pa nila ang receipts as proof na nagbayad kayo. Pero puede naman nilang tingnan sa records nila. Xerox your notice.

  59. Naconfine nanay ko and diagnosed by the attending physician
    As multiple cerebral infarction. Then nag bill kami Ng 47000. Magkano po marerefund ko?

  60. My mom was admitted last Jul 15 and was discharged on Jul 18, 2013. I was forced to pay the billed amount in full because I wasnt able to complete the required docs for philhealth claim. After 2 days I was able to complete the docs and filed it in the hospital (philhealth). I wasnt able to have a receiving copy when i filed it to them, how can i check if they were able to file it at philhealth office, just to make sure. Thanks

    1. Hi Anne, you can ask the hospital after a week if they’ve filed it already with Philhealth. You can also call Philhealth with your Philhealth no. and confinement details. Or write your concern at Philhealth’s Facebook page

  61. gud eve po. dumating n po ung notice q galing s philhealth, dumating n rin po dw ung checque nko s ospital. hinahanapan poi aq ng resibo ng medicine n binili ko sa labas. ang problema po ay nawawala po ung mga resibo ng gamot n binili ko sa labas. meron po akong payment ng billing s ospital n kumpleto po lahat ng computation mula sa ospital, doctors, andon din po pati ung computation ng gamot n binili q s labas. meron p po bang ibang paraan pra po ma claim ko ung checque ko sa ospital? salamat po at naway masagot nyo po ang mga katanungan ko..

    1. Hi jolly, pa-xerox mo ang notice at bill mo for your own copy, then present to the hospital the original docs. Makiusap ka na lang dahil nakasulat naman sa computation paper ang mga meds na binili mo sa labas.

  62. hi gud day!!! i’m lisa i want to ask my father as confine to hospital lst feb.2012 undergo i eye operation my question is how can i claim my refund b’coz im already working here in qatar

    1. Hi lisa, na-file ba ang claim mo? Kung hindi pa na-file, sorry hindi na puedeng mag-file kasi within 60 days after treatment dapat ang claim filing. Kung na-file naman, a benefit payment notice will be sent to the address you wrote in the claim form.

  63. Good day! About sa reimbursement, napasa ko yung documents requirement sa Philhealth Calamba nung June 11, 2013 and sabi sakin nung nag- receive is after 60 days tatawag ako sa number na to 049 5025697. yung reimbursement is sa papa ko diagnose ng LC, but he died june 14 same yr. makukuha pa ba namin yung reimbursement?

    1. Hi Geezle, you will get the check but you cannot encash it, so you call Philhealth calamba or go there with your ID and birth certificate, and your father’s death certificate (orig and xerox) and ask if you can file those now so they can issue the refund check in your name. By the way, they will ask about your mother, who is the primary claimant.

  64. Good day! Its been 2 months na after ko i-file yung reimbursement ng papa ko for his CT Planning because he was diagnose of CL. sabi kasi nung nag-receive tatawag daw ako after 60 days, is it working days?

  65. For prenatal care for pregnant woman, what if I did my cbc, urinalysis, ultrasound and oral glucose tolerance tests in another clinic and not in the same clinic that I will be giving birth, can I still ask for a refund for the expenses? Can I file them separately?

    1. Hi yongskie, you submit your prenatal ORs to the clinic where you will deliver. The maternity claim and the prenatal claim should be submitted together.

  66. Will the reimbursement be given to me or will that be given to the maternity clinic? if it excess P1500.00, are they only going to refund P1500.00 or will they refund the total of the ORs that I submitted?

    1. Hi yongskie, the prenatal care check will be issued in your name. Philhealth refunds up to 1500 only for prenatal care.

  67. hello po. tanung ko lang po. na operahan po sa panga yong husband ko tapos dependent ko sya sa philhealth..wala kami nabayaran sa hospital, ang nabayaran lang namin is yong doctors fee worth 30,000 plus athesia 5200….nandito sa akin yong resibo sa doctors fee at athesia pwede ko pa ba to ma pa refund sa philhealth…pero yong ibang resibo namin lahat sa mga gamit ay nasa hospital na…Thank you very much…

    1. Hi Lyns, basta Philhealth-accredited ang hospital at doctor at makapag-submit ka ng claim, meron kang marefund. Yong mga claim papers pipirmahan ng doctor at hospital.

  68. Hello. My father in law is presently confined in Villamor Hospital since my brother in law is in the military and my father in law is his dependent. The hospital bills are free so we don’t have to pay for the room and the professional fees of the doctor, however, we had to buy the medicines outside since they are not available in the hospital. I was informed that we should submit the CF1 before he is discharged. My Q is, can I be reimbursed for the medicines that we bought outside the hospital? Should I use CF2? thanks.

    1. Hi c, yes, you can reimburse the meds you bought outside if the allocation for meds for his case was not consumed by the hospital. Yes, CF1 and CF2 are required.

  69. Hi po,
    tanong ko lang po. Kasi po last june 24-27, 2013 po n confine po ang baby ko tas aug. 16-21, 2013 n confine po ulit, hindi po b talaga nmin magagamit ang philhealt ko? Pareho po ang sakit hika po n may pneumonia.. Thanks pp.

    1. Hi marlon, sorry, ganon nga ang rule na kapag the same illness ang reason ng confinement of the same patient within 90 days, yong first confinement lang ang covered.

  70. hi, ask ko lng po na confine anak ko nung feb 2013 pa. all bills were covered with Medicard. so, in short wala ako binayaran during discharge sa hospital. can i still get a refund for this? Thanks.

    1. Hi dion, sorry, I think kung wala kang payment receipt, wala kang ma-refund. Did you sign a Philhealth claim form? If you did, palagay ko Medicard na ang nag-process ng Philhealth mo, at na-deduct na before discharge, or sila na ang tatanggap ng refund kasi sila ang nagbayad sa hospital. For most HMOs, they require their members to submit Philhealth claim papers, so that they pay only the part not paid by Philhealth. If Medicard also pays that part normally covered by Philhealth, then that’s unique in the industry — kudos to them.

  71. Hi, ask ko lang po kasi nakagat ako ng aso last May and gusto ko po sana ireimburse ung anti-rabies shot na nagastos ko sa Medical City. Ung ginamit po sakin vaccine is verorab. Covered po ba ito para mairemburse ko? And last May pa kc ako nakagat and natapos ung shots ko last June, may expiration din po ba ang pag reimburse ng ganito? 10k+ din po kasi ang nagastos ko sa anti- rabies shot pa lang. Wala rin ako nafill-up-an na form sa Philhealth before ako mag undergo ng injection kasi ER na po kame tumuloy. Thanks po

    1. Hi Julie, sana nakapag-file ka ng Philhealth before the last shot. Sorry, within 60 days after last treatment or discharge ang filing sa Philhealth. Pero ask others too baka lang meron akong na-miss na rule.

  72. Hi! Gud day po! please help me… I am currently undertaking a radiotherapy treatment due to my right elbow that has Malignant Neoplasm of Bone and Articular Cartilage of Limb. The hospital requirements for filing Philhealth is on a DAY-TO-DAY basis until the treatment ends, which is 35 days session… my problem is, can I file for reimbursement from Philhealth if I missed to give necessary documents(ex. 2days of treatment) to the hospital while I am having a treatment? Thanks.

    1. Hi Janice, I think you can, since the deadline for filing for refund is within 60 days after discharge (pero ask others too para sure). Mas convenient kapag ma-submit mo na lang everyday, para automatic deduction na, at hindi mo na hahanapin pa yong mga medical personnel na pipirma ng claim forms mo. Ang alam ko puede ang clear copies ng MDR, clear copies of Philhealth premium receipts, and then get many claim form 1 sheets.

  73. Hello,

    Nanganak po ako last year na PhIC accredited din. dat tym wla pa akong Phic so nagprocess pa ako.. It takes a year nang makita ko yung receipt namin na binayaran sa hospital kasi nadischarged ako na payed full. pwede ba pa mairefund yun?

    Che

    1. Hi Cherry, do you mean you filed your Philhealth papers with the hospital after discharge? Have you received a benefit payment notice from Philhealth? Pero kung walang notice pero more than a year na, xerox your receipt and then go to the hospital and ask for your refund. Ang kaso lang is baka sabihin ng hospital na hindi pa na-process ang claim mo kasi wala kang maipakitang notice. But if you have time, you can try.

  74. hi good pm just want to ask na hospital last dec.24,2012 mother q may contributions xa sa philhealth 17 yrs tpos ng retire xa sa company as in ndi nya nagamit ung philhealth nya during nung ngwowork xa gsto q lng malaman na may reinbursement pa ba kmi na mkukuha since ndi nya nmn ngamit nmn un? super laki kc ng nagastos nmin tpos n di nmin napakinabangan ung naging contributions nya?

    1. Hi cons, hindi ko sure ang home treatment kasi dapat merong Philhealth accredited na medical professional at saka dapat sa Philhealth accredited facility. Please visit Philhealth and ask or call Philhealth 441-7442

  75. Hi po, ask ko lang. May mga late payments po kami sa Monthly Contribution nami starting May till August. And yung boss ko is scheduled for a surgery next week. Pag na settle na ba yung payments eh pwede na mka.avail agad sa benefits? Thanks

    1. Hi Sheena, yes, dapat bayaran nio na asap, today if possible. Oct 10 ang deadline for those employed? Not sure if you can still pay for 2nd quarter; okay lang kung puedeng magbayad ng penalty.
      If paid ang 3 of the 6 months before surgery, yes, eligible ang boss nio.

  76. Good day! I am giving birth soon but the center that I am planning to give birth is not philhealth accredited. Can they still give a refund for that kind of situation?

  77. Hi, Just want to know if my philhealt is not yet updated or my contribution is not yet showing up on the system on my current employer but my last contribution is on march pa, tapos nahospital yung anak ko then the hospital cannot honor my philhealth kasi last payment ko pa is march or last year pa po. Nagamit ko yung HMO ko pero half lang nagamit kasi dahil sa philhealth ko so binayaran ko ng cash yung kalahati po. Eligible po ba ako sa reimbursement? 1 week plang nakakaraan na nakalabas daughter ko [o.

    1. Hi Tomi, sorry, if your last premium payment was March 2013 and your child’s confinement was Sep or Oct, you cannot avail of Philhealth coverage. You should have paid at least 3 of the 6 months immediately before month of confinement.

  78. HI, ask ko lang po kung paano po ba yung process ng meds na binili outside of the hospital, ipinasa ko po yung lahat ng receipt sa meds amounting to almost 90k dun sa philhealth rep sa hospital, after 6 months ang lumabas na cheke ay para sa hospital nakapangalan. Then i filed for re evaluation of the previously attached receipt and created a letter attaching it to the form sa philhealth grace park caloocan, after 3 months may check na and it’s only 10k. hinde po ba lahat irere imburse ng philhealth yung meds na binili outside of the hospital? may be you can shed some light on this. or email me directly pogigwapo_09@yahoo.com
    thanks

  79. Hi, magandang araw po. Last June 21, 2013 nanganak po kasi ang asawa ko via CS in a government hospital. Wala na po kaming binayaran upon discharge sa hospital. Ang binayaran po namin ay iyong PF ng nag-CS at anesthesiologist. Binigay na rin po namin lahat ng requirement para sa Philhealth reimbursement sa mga medicines dahil binili namin ang mga gamot outside the hospital kasi hindi available sa kanila. Dumating po last week ung cheque at 800+ lang po ang amount na na-reimburse namin. Bakit po kaya? Tapos unwell pa po ang baby namin so dalawa po ung submitted naming forms, iisa lang po ang dumating.

    1. Hi Denver, did you also receive a benefit payment notice? How much was paid to the hospital? 19k? If so, xerox your notice and your PF receipt and then ask the hospital your additional refund (PF). Did your meds cost more than 800? If so, then ask also for additional refund.

  80. hi po, can I apply refund for cash payment I’ve been
    made for the medicine injected to me nung mag labor at manganak po ako last Oct. 14 sa isang lying in malapit sa amin, accredited po ng philhealth..

  81. HI!
    Nag undergo ako ng chemo. I will reimburse my medicine na binili ko personally. Ang chemo ko ginagawa sa ospital na accredited ng philhealth Nun ginawa yun chemo ko yun PF ng doctor was covered by our HMO pati yun ER charges. Pwede ko pa rin bang i-reimburse yun mga medicine na ginamit sa ko na binili ko outside with my doctors order kasi wala naman meds yun ospital para sa chemo ko.Ano requirement at how much ang maximum na pwede ma reimburse. I was diagnosed Stage 3A breast cancer.

    Please reply asap. Thanks.
    agnes

    1. Hi Agnes, you can file your claim with Philhealth but you need to get forms and waivers from the hospital and doctor. Chemo is not yet under Case Rate, so I can’t give an estimate. You can also try calling your HMO and ask about refunding the meds you purchased. You can also ask Philhealth about their Case Type Z benefit program for breast cancer patients.

    1. Hi bong, within 60 days after discharge ang time to file your claim. Kung nareject at merong re-filing instruction, yong ang puedeng i-extend. Ask Philhealth.

  82. hello po. ask ko lang po if nawala ko yung slip na galing sa ospital for refund makukuha q pa din po ba yung refund ko by presenting my philheath id??? thanks.

  83. Good day! I was a little bit confused.. My mom was confined last September 29 and discharged last October 12.. She’s only 44 yrs old and cannot be a dependent on my philhealth.. I applied her in philhealth last November 7 and I pay 1800 for the whole year of 2013 sa so I can used it already.. Can I reimburse all her medicines during and after her confinement? And how about our hospital bills including professional fees?? Thanks..

    1. Hi Clarisse, your mother can not use her Philhealth for her Sep-Oct confinement because she started her membership only this Nov, meaning she was not yet a member when she was confined. She can use it for future needs.

  84. Good p am po. 5 months na po ko ng pananganak ang anak ko. CS po ako, napasa ko po lahat ng requirements ko kaso hanngang ngayon wala parin ako natatanggap na BPN. Panu po yon Via mail or E-mail po? thank you po

  85. Tanong ko lang po sana kung puede i convert sa pera ang philhealth ng tita ko .. Teacher po kc sya pero retired na at d pa napaprocess ang papers nya dhil sa kakulangan ng pera madala po kc magkasakit ang tita ko puro check up at gamot kaya gusto ko malaman kung puede bang makakuha ng refund or pera si tita ko sa philealth

  86. Hi Nors!

    I just want to ask, I have HMO which covered almost half of my hospital bill. I paid the remaining cash. Will the reimbursement be the same exact amount I paid cash? Cause I heard, I will not be able to get the same amount I paid. Thank you!

    1. Hi Ago, how did your HMO computed its share of the bill if your Philhealth coverage was not considered in the bill? Usually, HMO pays the full balance after the Philhealth coverage is deducted. After you get your benefit payment notice or refund check, and it’s lower than what you have paid in cash, request for refund of the discrepancy from your HMO because the usual rule for HMO is that they pay the portion of the bill that Philhealth does not pay. Of course, refund only from your HMO if you have not yet consumed your maximum HMO benefit limit.

      1. gud day po, ask ko lang po out patient ba d sya 24 hrs na confine sa hospital pero she undergone operation she can avail reimbursement from philheath she is government employee sayang naman ung payment nya d nya ma avail discount ng philhealth…hope in this case be considerate..tnx

        1. Hi Malyn, yes, mag-request kayo ng Philhealth claim papers from the hospital then file with Philhealth. Other docs required: MDR and premium payment receipt.

  87. hello good day…ask ko lang po about the philhealth 60 day rule if applicable pa siya kasi I went to ask recently sa philhealth office region 9 they said pag after 60 days hindi nasubmit ung necessary requirements I can still submit pa rin mga requirements including a letter of appeal(stating my reason kung bakit nalate ang pagsubmit) although it will take much longer daw to receive the check and ganun din sabi sa hospital kung san naconfine mother ko. I hope na may makuha kame kahit konti kasi sayang naman talaga.

    1. Hi Mae, yes, deadline policy pa rin yong 60 days. At isa pa ring major reason yan for denied claims. Puede sigurong iconsider ng Philhealth kung natural disaster ang reason for filing late, pero hindi ko sure.

  88. Hi, ive gave birth last july of this year, 25k pinagbayaran ko sa hospital for cs delivery, and then hospital na nag-ayos for benefits claim from Phlhealth, pag ganon po bang scenarion, may marerefund pa ako? may nareceived akong letter yesterday from Philhealth, indicating ung amount ng hospital charges, prof. charges…un lang, ano po yun??thanks

    1. Hi Mara, check mo uli yong statement of account mo and OR mo. Nadeduct ba agad yong coverage mo na 19k? Or nadeduct ba ang 11400 from hospital expense? If yes, wala ka nang marerefund, kasi nai-apply na yong benefit mo sa billing. Kung hindi nadeduct ang PF na 7600, puedeng tanungin ang OB or hospital, pero usually hindi na nagrerefund ang OB, additional PF na nila yong 7600. If zero Philhealth deduction, then ask for refund. Xerox your billing, BPN, and OR.

  89. Hi! Ask ko lang po if nadala sa ER yung patient tapos nadischarge din within 24hrs at hindi na confine posible po bang irefund sa philhealth yung bill n’ya at mga nagastos na gamot? Thanks.

    1. Hi riean, usually hindi na po, kasi hindi na-confine. Merong certain outpatient surgeries na covered. Ask mo na lang yong hospital.

  90. Hi, good day! I already submitted all the requirements for claims and they gave me the tranmittal so it means I completed all the documents needed, and now when I ff up the check they said incomplete ang documents kaya wala pa, what will I do if its their fault that they lost it and now they want me to provide again the missing docs? And by the way it saids that if I have the official receipt I dont need the waiver from the doctor but why are they still requiring it? Thanks.

    1. Hi Jill, did they say that all the docs were lost? Baka yong waiver lang ang missing. Mas okay na merong waiver para ilagay na nila in your name yong check.

  91. ask ko lang po if pwede bang humingi ng refund sa philhealth sa mga gamot na nabili namin sa labas ng hospital while my husband was confined kasi po lumagpas na kami sa aming insurance. pls reply, tnx.

    1. Hi lans, private insurance ba yong nagamit? O Philhealth din? Kapag Philhealth at nagamit na lahat ang coverage, wala na pong additional refund. Kapag hindi pa nagamit ang Philhealth, puede pang mag-file basta makakuha kayo ng filled-up claim forms sa hospital.

  92. hi, na-admit kc kapatid ko and as of now nkalabas na kami ng hospital, pero wala kc cya philhealth so yung philhealth portion sa bill eh binayaran nmin. My question is if marreimburse ba nmin yung binayad nmin kung ipamember ko sya ngaun sa philhealth at bayaran ko yung 1yr. na contribution (i think 1800pesos)?

    thanks…

  93. Happy New Year Po!! Naadmit po ako sa PGH Maynila noong June 25, 2013 para po sa operasyon!! Member po ako ng Phlihealth! Bakit po ganun nag submit naman po ako lahat ng kailngan requirments for Refundable sa Philhealth po! nag follow up po ako naung January 6,2014 sa Philhealth MAlolos, Bulacan ay wala daw po sa data base nila!!! Pano po ba gagawin ko po para maka refund po ako!!! GOD Bless po!!

    1. Hi Edwin, sori hindi ko ma-guess kung anong nangyari. Nai-file kaya ng Philhealth ang claim mo? Follow-up mo na lang sa PGH. Happy new year and God bless din.

    1. Hi stephanie, merong isang nag-comment dito na ganon nga raw. Sori wala pa akong nabasang circular about it. Will get back if I see something.
      Nakita ko na yong circular. Sabi sa circular, dapat hospital na ang mag-file ng claims. Meron daw few exceptions; palagay ko yong mga hospitalized abroad.

  94. Pag dumating na po ba samin u g bpn at naipasa ko na lahat ng OR ko,ganu nmn po ktgal mag issue ng check,plz reply

  95. gud pm.naconfind po ako last oct.19 to 22 2013 member po ako ng philhealth’kaya lang po hinde ko po nagamit ung philhealth dahil hinde po agad naipadala ng agency nmin.na operahan po ako ng apendisitis ang binayaran ko lahat sa hospital 59.594 lahat po ng ducument na kailangan sa philhealth office na ayos ko na po na recieved na po last dec.5 2013 at binigyan po ako ng recieving copy ,magkano po kaya ang maire inverse ko,slamat po and GOD BLESS

    1. Hi jerry, based on the new Case Rate chart, ang coverage for appendectomy is 24k (14,400 for hospital cost and 9600 for PF). God bless din

  96. Good Day!

    I just want to ask on how to get my Philhealth refund. I already ask the hospital but they said they need the notice came from Philhealth but I didn’t received it yet . I was confined last March 2013 and the hospital said they already have the refund last November 2013 but they need me to pass the notice i didn’t received it till now.
    How can i get the notice of refund?

    1. Hi Erica Rose, dapat natanggap mo ang Philhealth notice from your postman. Ask your post office. Registered ang notice, so meron sila sa record nila.

  97. Hello po, gusto ko lang po sana malaman kung pano po malalaman yung pwedeng mareimburse for liver cirrhosis/cancer case. Patient is only dependent ng wife which is a Philhealth member. Thanks in advance for your help.

    1. Hi Sam, sa Case Rate list, ang coverage ay 11,800 at 15,100 ang coverage, depende sa case ng liver cirrhosis. Hospital cost at PF coverage na yan. Ask the hospital or doctor

      1. Hi Nors, thanks for the info. Kasi we spent 400k for all hospital bills including PF, then hospital only deducted 10k for Philhealth. Do you think it’s normal? I think the hospital didn’t follow the right rate.

  98. helow sir, we already received bpn, ang problema nwawala ang resibo namin, anu po sasbhn namin sa hospital pede po b kam kumuha ng copy sa kanila? thank you!

    1. Hi jayson, xerox your bpn so you have your own copy. Yes, you can try asking for a copy from the cashier/collection dept. but hospital have different policies, so I’m not sure.

    1. Hi anate, fixed na po ngayon ang refund, depende sa sakit o procedure na ginawa. At wala na pong direct filing with Philhealth; dapat i-submit ang Philhealth docs sa hospital before discharge.

      1. hi nors. sorry if nadoble tong comment, im not sure kung nagpost yung una. anyway, i heard na wala na nga daw direct filing/reimbursement. pero what about emergency outpatient cases na mahirap magcomplete ng requirements before discharge. would you know kung possible parin reimbursement? thanks!

        1. Hi ting, ang nakasulat sa Philhealth circular ay wala nang direct filing except for certain cases, so I hope kasama ang emergency sa exception. Try your best to submit your docs before discharge. Note also that not all outpatient emergency cases are covered, so ask the hospital.

      2. Hi ting, dinidiscourage na ng Philhealth ang direct filing. Try your best to submit your Philhealth docs to the hospital before discharge. Not all emergency outpatient cases are covered, so ask the hospital.

  99. hello po! i had my hysterectomy operation last January 21, 2014.. i was discharged on January 26, 2014.. ang tanong ko po nag bayad po ako sa hospital bill ng 31,915 kc di ko na file ang Philhealth ko. the amount of my hospital bill is 79,311..so after 2 days nag submit na po ako ng complete requirements for refund.. magkano po kaya yong makukuha ko na refund? member din po ako sa medicard health card sa company namin..thanks and need your response soon..

  100. gud evening!! ask ko lang po ako db ang total hysterectomy package is 30k? na operahan po kc ako last January 21, 2014.. wala po akong binayad sa hospital kc my MEDICARD HEALTH CARD po ako sa company namin.. upon discharged po nagbayad po ako sa hospital ng 31,915 kc po di ko nagamit ang Philhealth ko kc nagkulang po ako ng requirements..sabi sa hospital mag file na lang daw ako for reimbursement. magkano kaya ang makukuha ko pa na pera sa PHILHEALTH?

  101. hello, ask ko lng po kc nahospital ang anak ko nung nov.2013 pa at ngfile ako sa philhealth ng dec.2013 pa para sa reinbursement sbi sa philhealth 2months lang daw pero hanggang ngayon wala pa din yung claims ko. palagi akong ngfofollow up sa philhealth hanggang ngayon wala pa din almost 3months na, bakit kaya ganon katagal? thanks.

    1. Hi mari, sad to say na matagal pa rin ang claim processing. Umaabot pa rin ng 3 to 5 months or more. Mag-comment ka sa Facebook page ng Philhealth.

  102. hi po paano po ang gagawin kung wala philhealth ung hospital ? n confine kase ako ngayon paano po kya ito panu ko magagamit philhealth ko?

  103. Ang byenan ko ay naconfine sa PGH ng Feb. 9. Pero sabi ng Philhealth sa PGH di na raw pwedeng mag reimburse. Totoo ba ito? Kasi di namin magamit ang philhealth ng asawa ko. ty

    1. Hi Minerva, hindi ba kayo sinabihan na dapat mag-submit kayo ng Philhealth papers sa PGH before discharge para maka-refund kayo later on? Ang alam kong hindi na puede ay ang direct filing sa Philhealth.

  104. hello po. kailan po ba namin makukuha ung refund ng philhealth nang husband ko? naconfine xia last december pa sa vicente sotto hospital in cebu city. sabi nila 3 months lang daw at dadating na sa amin ung refund. ee hanggang ngayon wala pa. complete naman ung requirements na pinasa namin.

  105. ask ko lang po.. kc pinakuha ako resibo ng pinagbayaran ng philhealth..eh online nagbabayad yung employer ko. txka yung dala ko na papel is yung print lng na payment lahat.ok lng po b yun? thnx po sa reply

    1. Hi jhunnel, dapat kung meron ka nang MDR from Philhealth, signed claim form 1 and certificate of premium payments from your employer plus your printout na andon ang name mo, dapat puede na.

  106. Good pm! Package deal po ako sa aking panganganak at 5000 po ang na deduct sa akin ng philhealth. Tanong ko po kung totoo po ba na may refund sa mga naibili naming gamot at iyong down payment sa prenatal? Salamat po.

    1. Hi sheenaya, 5k lang ang Philhealth deduction for delivery sa hospital, so wala nang refund sa nagasto sa gamot. Merong 1500 na coverage for prenatal (to be refunded by Philhealth at hindi dinededuct ng hospital), pero dapat nakapag-submit ka ng prenatal ORs before discharge para naisabay sa maternity claim.

  107. Hi. I’d like to ask something about PF. I’m giving birth in May in a government hospital which is Phlhealth accredited. I haven’t ask yet my doctor (affiliated both private and public) if she’s philhealth accredited physician. I tried checking her name on Philhealth website and unfortunately her name was not there. Will I be paying for PF then? If so, am I eligible for refund? Pls advice.

  108. sa lying in clinic po ako nanganak last year september 27 2013. ask ko lang po kung makakarefund po ba ako sa philhealth… accredited din nman po ng philhealth ung clinic

    1. Hi chell, kung nagbigay ka ng Philhealth docs sa kanila at na-file nila sa Philhealth, wait for your benefit payment notice from Philhealth and then ask for a refund from the lying-in

  109. Hi po tnong ko lng po yon po bang benefit refund ng philhealth ay yong deduction ko sa bill ng hospital for philhealth yon po b yong amount na makukuha ko. Tnx po.

    1. Hi letty, yes, yong Philhealth deduction sa bill mo ay yon na ang benefit mo. Pag government hospital na merong binibili sa labas, puedeng irefund yong nagasto kung meron pang available coverage.

  110. Hello po gud afternoon ma’am/ sir.. pwd po bng magtanong saan po kaya nkakakuha ng mga form para po maclaim ung irerefund po.. thank you po :) mula po kc nung pqgkatapos naoperahan po sa katarata ung lola ko po wala na po kming balita.. 7 months na po ang nkalilipas thank you po have a nica day.. gobless

    1. Hi isabel, pumayag ba ang doctor na gagamit kayo ng Philhealth? Nag-file ba siya ng pre-approval sa Philhealth before the cataract operation? At nag-file ba ang doctor/hospital sa Philhealth ng claim after the operation?

  111. Hello Good Evening,

    Ask ko lang ko. My son was admitted last April 3-5. Wala kami nabayaran sa hospital kasi 10,500 ang cover ng philhealth. My son was admitted due to pneumonia po. Our hospital bill was 4,500. Makukuha ko ba yong remaining po?tapos my mga medicines nabili sa labas tapos hindi po tinanggap ng hospital.

    1. Hi Angelie, wait for your notice from Philhealth. If the notice shows that Philhealth paid the hospital 10,500, ask the hospital for refund for the medicines you bought outside. Bring your bill and receipts (orig and xerox).

  112. Maam paano po kaya yung case namin ,naipasa na po nmin lahat ng requirements pero my isang document na hindi kinuha tapos nung finallow up namin after a month sabi po wait ng letter sohinintay po namin and after 4th 5th 6th 7th month wait parin daw po then we came back at the hospital this 10th month hindi daw na process ksi kulang po yung required papers kaya hindi na transmit sa philhealth pwd pa po kayang ireimburse yun at ifile ngayon ?

    1. Hi Charity, merong deadline ang filing with Philhealth — within 60 days after discharge. Magreklamo kayo sa hospital management kung nasa kanila ang mistake.

  113. db po worth of 6k ang sagutin ng philhealth sa hospital ones na member ka nito .,. what if po kung wala pang 6k ang inabot ng bill ko sa hospital ? ano na po mangyayari sa natira ?! hndi ba ito mkukuha us cash ?

  114. hello!! tanong ko lang po yong package ng total abdominal hysterectromy ay 30k. yon din po ba ang makukuha ko sa refund ko pagdating ng BPN notice ko?

  115. hi po,i was confined last april 22-23 sa ARO Medical center, hindi po sila philhealth accredited. ask ko lang po kung pwede mag pa reimburse sa phil health ng medications na almost 10k na nagastos ko on that said clinic? please answer po. thank u!

    1. Hi yhannie, sori, hindi puede kasi dapat Philhealth accredited ang hospital. Bawal na rin ngayon ang direct filing with Philhealth. Ask others too.

  116. Hi, di ko pa naaadd ang baby ko as one of my beneficiaries then nahospitalized siya.. Pwd ko po b siyang iadd as my beneficiary at the same time gmitin ang philihealth to pay for the hospital bill?thank you

    1. Hi Grace, yes, present your baby’s birth certificate to the hospital (orig and xerox). Yong ibang hospital, enough na ang birth cert; others require you to update your MDR with your baby written as your dependent in your MDR.

  117. hi!! tanong ko lang po kung kailan ko mare received ang BPN ko!! nag file po ang hospital nong MARCH 3, 2014.. KAILAN KO PO MALAMAN ANG EXACT AMOUNT NG MA RE RECEIVED KO? upon discharged nag bayad po ako ng 31,915.. total abdominal hystertomy ang inopera sa akin which is 30k ang total package

    1. Hi jerah, BPN is sent by Philhealth. Did you submit Philhealth docs to the hospital? If yes, wait for your BPN, then ask the hospital for refund. Bring your BPN, bill and ORs.

  118. Wala pa po akong Philhealth nung nanganak ang misis ko (2012) at nung naconfine yung anak ko (twice, 2013), pero po ngayon meron na, tanong ko lang po kung maipapareimburse ko po ba yun? thanks.

  119. hello po…ask lang po kung gaano katagal ang proseso sa pagrerefund? 5 months na po kasi hanggang ngayon malabo pa rin :( thank you po

  120. ..ask ko lang po naconfine po sa ICU kasi ang anak ko New Born baby po siya since April 22,2014 until now panu po ba ako makakakuha ng refund sa philhealth since auko po gamitin yun philhealth ko sa billing ko sa hospital?

  121. Hi po Philhealth ask ko lng po. Yong philhealth ng asawa ko di na change status dapat kasi married status na at isa ako sa dependents. This month manganganak na ako. Possible pa po bang magsubmit ng requirements para po makahabol at magamit ng asawa ko un philhealth niya during my delivery sa hospital??

  122. Hi po Philhealth tanong lang po. Yong philhealth ng husband ko hindi po na update yon status dapat po kasi married at isa ako sa dependent niya as his wife. Pwede pa po bang mahabol ang pagsubmit ng requirements na ngayong buwan na to kabuwanan ko na para nman ma avail namin yon benefits during my delivery at the hospital. Ano po bang pwedeng gawin???

  123. good PM!! just asking about my reimbursement that until now i havent received yet.. its almost 4 months na po

  124. gud pm..this all about the refund.my nephew as the memeber of philhealth.his father was admitted at perpetual soccour hospital.we paid all the bills since the requirements for philhealth was submitted 2 weeks late…my question is..the member received benefits payment notice.the amount was p9000 for asthma as primary diagnosis.now wen we went to philhealth at perpetual soccour hospital the amt of p9000 the memeber will only received p6300 as said by philhealth staff.she said that the 30% 0f p9000 will go to the attending physsicians as the doctors benefits from philhealth.please explain how it come up like this.im confused.

    1. Hi mercy, the 9k coverage is allotted as 2,700 for doctor and 6,300 for hospital costs. If you already paid the doctor’s PF, you should get the 2,700 as refund. But some hospitals or doctors get the 2,700 as additional PF.

  125. hi!! nag file po ako ng Philhealth ko last MARCH 3, 2014 ay naipasa na po ng hospital.. pwd ko po ba palitan and address ko na instead sa home adress ilipat ko sa office address namin na lang?

  126. HI GUD DAY MERON PO AKO REIMBURSTMENT KO IF IM NOT MISTAKEN AUGUST2012 AKO NG FILE AND UNTIL NOW WALA P RIN AKO N RECIEVE NA REFUND FROM PHILHEALTH NAISIP KO LNG KUNG SAAN N PUPUNTA UNG MGA GANUN CASE KC UNG IBA NGSASAWA N MG FOLLOWUP ANG SKIN LNG PO KHIT MALIIT N HALAGA ANG MA REFUND KO MALAKING BAGAY N SKIN KASO FEELING KO NATABUNAN NA UNG FILE KO..NAMUTI NA UNG MATA KAKAANATY NG MAIL FROM THEM….

    1. Hi Mary Ann, that’s a really long long time. It’s now 2014. Sorry I can’t know what happened to your file.

  127. Gud am. Ask ko lng po kung pwede po ba mairefund ung binayad nmin sa hospital nanganak po kz aq CS umabot po lht sa 55tw ubg gonastos nmin..actually po dko po alam n my phil health po aq bgla nlng po dumating ung MDR n member n po aq sa philhealth pero coverage po aq ng NHTS ung employer/organized group ko po ay DOH..dumating po kz ung MDR ko nkalabas n po kmi ng hospital april 22 po aq lumabas dumting ung MDR ko may 9 n po.. Pwede po b aq mkpgrefund pag gnun?

    1. Hi evelyn, I’m not sure if Philhealth is still strict with its rule that there’s no more direct filing with them. You can try. File within 60 days after discharge.

  128. Hi.

    ask ko lang po, paano kung hindi ko po natanggap ang BPN or hindi nahanap ng postman ang bahay namin. saan po ba bumabalik ang BPN para po mai-verify namin.

    Salamat

    Best Regards,

    1. Hi juneart, go to your postman and ask. There’s a list for registered mail. Or you can go to the nearest Philhealth branch.

  129. Hi po! Ask ko lng po about s philhealth ng m0ther ko, nagrenew po sya nung dec.2013 ng indigent philhealth nya for 2014 po un s brgy. nmin d2 s Malay province of Aklan. Then, nconfined po sya s St.jude h0spital @ kalibo nitong May18 lng due to pneum0nia. Nung mlapt n po kmi mgdischarge, inasikaso ko na po ung philhealth nya pra maLess ung ba2yaran nmin s ospital. Pro pgcheck po s computer ng philhealth office ng ospital, wla dw pong record c mama na updated or nrenew nya ung indigent philhealth nya. Nagbayad po kmi ng 24,011 pesos pra s h0spital bill and doctor’s pf. for 6days c0nfinement. Nung nagbayad po ako sa casher, 3day lng po ibinigay nla smin to update my m0ther’s philhealth to claim the refund s knila worth 10,500. Ask ko po if mare2new b nmin until wednesday ung philhealth? Ano2 po b ung dpat nmin gwin pra mk0mpleto lhat ng process. Dmi na po kz nmin utang. Malaking tul0ng po smin ung 10,500 if ever mrefund un. Plz po. Turuan nyo po ako ng step by step kc first time plng po kmi ga2mit ng philhealth. Hoping 4 ur emmidiate responce. Salamat po.

    1. Hi Jhe, sorry my reply is already late, so I hope you asked other people. You could have gone back to your barangay and ask.

  130. Hello mam..

    Ask koh lang po if walang gamot sa ospital tapos no choice kaning bumili sa labas.. pwede po ba irefund ung nagastos na gamot na nabili sa labas?

    1. Hi Lyn, yes, submit your Philhealth papers to the hospital. Later on when the benefit payment notice from Philhealth shows that your deduction is less than what Philhealth paid to the hospital, go to the hospital with your ORs and bill and ask for refund.

  131. hello! i was operated last january 20, 2014.. i filled my philhealth in the hospital. until now i havent received the BPN number kc sabi doon sa Philheath sa my Caloocan denied daw po..pwd po ba yong hospital na lang ang magbayad sa akin at mag issue ng check? its almost 4 months na po

  132. Hi, ask ko lang po. Yung baby ko kase naconfine lastweek lang. Then, nagasikaso ako ng papers. Meron akong isang kulang na receipt na binayaran ng tita ko individually. Yung tita ko kase lives in marikina. dito pa kme sa qc. Hndi pinayagan ng hospital na gmitin ung philhealth ko khit nag-ask nmn ako sa philhealth kung pwede. Ang daming dahilan, kesyo di pdw nila nattawagan ung philhealth dahil coffee break ganito ganyan. Ang itatanung ko lang po sa case ko ano po ba ang mga requirements? And patulong naman po sa paggawa ng letter of consideration. Hindi ko po kase alam kung pano ggwin dun. Thanks.

    1. Hi Shiela, you can write to Philhealth in Tagalog and request them to accept your claim documents and explain why you were not able to submit your documents to the hospital.

  133. I am married pero nghiwalay na kmi ng husband ko.then im pregnant nw .pero hndi sa husband k..kya ung apelyido ko sa philhealth is when im married pero now ang gmit k sa hospital is nung dalaga ako…ako mismo ung member…pno ko magagamit ung philhealth ko kung ung apelyido ko nung dalaga ako un ang gmit k

    1. Hi jackie, it’s easier if your names with Philhealth, your premium receipt and your IDs are the same, so the hospital does not have to ask questions. You can request for a change in name with Philhealth, but you need court declaration of annulment, so it’s difficult. If there’s still time, and if you decide so, register anew with a new Philhealth no. and your maiden name. Or you can use your married name at the hospital, but your baby’s surname will be your maiden surname or the surname of your baby’s father. Ask others too.

  134. good pm!! pwd po ba ako gumawa ng APPEAL LETTER sa Philhealt regarding my claims? na discharge po kc ako last JANUARY 26, 2014 nagkulang kc ako ng requirements upon discharge kaya ako muna nag shoulder ng bayad.. salamat po

    1. Hi anafe, do you mean you’re filing only now? There’s a deadline for filing; file within 60 days after discharge.

  135. Hi
    tanong ko lang po member na po ako ng philhealth since year 2006
    then i got pregnant and going to use my maternity benefits for the first time,but I’m on long leave in our company without pay since January 2014 at this June po ako manganganak,may makukuha po ba akong refunds or something from philhealth?i think nag stop maghulog ung company nmin nung february sa philhealth account ko,
    tnx po..

    1. Hi jenny, pay your premiums as Individual Payor for April and May so you can avail. Requirement: Payment of 3 premiums within 6 months before confinement

  136. hello po ask ko lang po kung pwede pa po ba ako mag apply for reimbursement/refund kasi ung tita ko po ay naoperahan nung april 2014 po pero hindi po sila nakapag ayos ng papers para sa philhealth na ipapasa sana para madeduct sa philhealth nea pwede pa po ba kami mag file for reimbursement? please reply po salamat

    1. Hi rhona, you should have filed papers for deduction before discharge. Philhealth issued a rule that there’s no more direct filing. But you can try. File within 60 days after discharge

  137. Gud am po.ask ko lng po kng pano nmin mareimburse ung mga meds n binili nmin sa lbas .my mom was hospitalized last may of ds yr.the philhealth dscount was applied sa bill pero pano po ung mga receipts ng gamot galing sa lbas.almost 9k p po un kc 2 hospitals po na-confine mother ko.tnx

    1. Hi shelah, wait for your benefit payment notice from Philhealth, and if the deduction was less than what Philhealth paid to the hospital, bring your notice and ORs to the hospital and claim additional refund.

  138. Good day! just want to ask kung pwede pa po ba gumawa ng appeal letter for refund. na ospital po kc yung lola ko last january 2014 and nadischarge din po after a week. sbi po sa ospital pwedeng kame nalang po ang mag lakad ng papers for reimbursment. then nung nagpunta naman kmi sa philhealth, sbi naman po dapat dw sa hospital yun. di na po namen alam kung anung process ang susundin kaya hindi na nalakad yung papel. recently may nagsabi n dapat mag email kame sa philhealth. pwede pa po kaya yun?

    1. Hi maries, you can try. But filing should be within 60 days after discharge. And papers should have been submitted to the hospital so the coverage was deducted from the bill

  139. Hi Nors,
    Question naman, paano ako magpaparefund. Nadischarge mom ko nung April 17, ako muna nagshoulder ng Philhealth Fee dahil mahal na araw yun at sarado sila. Now, according to your website di na pwedeng dumirecho sa Philhealt. So does it mean na babalik ako sa Makati Med para ayusin yung refund ng mom ko and if ever ano kayang documents ang kailangan kong dalhin. Thank you. :)

    1. Hi Bev, you only have 60 days from discharge to file. Sorry I’m not sure if Philhealth still accepts direct filing. Docs are in the list above. Bring your bill and OR so you can get claim papers from Makati Med

  140. Good evening po..just want to ask kasi nakatanggap na ako ng bpn from philhealth pero mas malaki ang amount na nadeduct ng philhealth sa hospital bill ng mother ko (beneficiary ko kasi sya).. compare dun sa na deduct ng hospital sa bill namin..ano po ba ang maaari kong gawin? Sa negros occidental pa ko ako pero sa paranaque medical na confine yung mother ko last september 2013

    1. Hi Ann, you can present your OR, bill and BPN to the hospital to get additional refund. But since you’re in Negros, call the hospital first.

  141. hi!! na denied po ang letter of appeal ko na pinasa sa Philhealth,Caloocam sabi don sa reason NOT COMPENSABLE> what does it mean? ang alam ko na late filling lang po ako kc january 26 ako na discharge so i was the one shouldered my expenses total of 31,915 with out reduction of my Philhealth claims.. pwd po ba ako mag appeal for the second time direct don sa main office branch ng Philhealth sa my Pasig City? kailangan ko po kc yong refund ko kc hiniram ko lang po yon sa kaibigan ko.. SALAMAT PO nad need your advice

  142. dinala sa er at namatay din ng araw na yun ang tatay ko. pero nung binayaran na namin ang bill, nakalimutan namin gamitin ang philhealth nya. pwede pa ba kami humingi ng refund?

    1. Hi Kenny, there could be consideration for your case. You try filing directly with Philhealth. Go back to the hospital and ask for claim papers.

  143. Ask ko lang po kung paano ko marereimburse yung sa mga medicine
    receipts ng father ko kung philhealth ko po ang gagamitin.
    thank you and regards

    1. Hi Dale, sad to say that Philhealth does not yet reimburse medicine receipts. Medicines are covered only when hospitalized, as part of the fixed Case Rate coverage.

  144. Hi,ask ko lang po if totoo bang you need to have atleast 4 check ups sa lying in to be considered na magagamit mo ang philhealth benefits mo? Kasi nanganak po ako pero stillbirth and niraspa ako (d&c) , sabi ng lying in di daw maaacredit dahil nakadalawang check up lang ako. Para unfair naman un na nagbabayad ako ng philhealth and then di ko magagamit,

    1. Hi jhoana, that 4-prenatal-visit rule was issued in a 2009 circular. But there have been many changes in rules since then. I’m still looking for the new circular related to this. D&C is also covered, but only in hospitals or surgical clinics.

  145. Hi, nanganak ako nung Sept. 2012, hindi ko sya nafile sa philhealth yung sa baby. Puwede pa ba akong magfile ng reimbursement?

    1. Hi jaja, the deadline for filing is within 60 days after discharge. Also, this year, direct filing with Philhealth is no longer allowed.

  146. hello po ask ko lang po if sa private hospital ko ako manganganak level 2 mga magkano po ang idededuct sa bill ko if NSD po ako, at paano po ba ung sa prenatal care ano pong ggawin dun? this july na po ako manganganak, updated nman po ang contributions ko, thanks po.

    1. Hi lyn, your deduction should be 5k (3k for hospital and 2k for PF). Submit your prenatal care ORs worth at least 1500 together with your Philhealth papers. Philhealth will refund your prenatal care via registered mail.

  147. hi po, nanganak po sis ko March 7, 2014 sa isang Lying in Clinic dito sa Taguig. Yung clinic na po nag process ng re-imbursement namin sa philhealth kase accredited naman daw po sila. Kaso po yung sis ko umuwi na sa probinsya pero yung mailing adress nya is dito sa taguig, in case po ba dumating na yung check ok lang na kami mag receive or we need to show authorization letter or may requirements pa sa courier para ma receive yung check nya? Thanks..

  148. Hi, na confine po ako sa st. Lukes under social service yung project po ng doctors nila. Ang part ko lang po na babayaran is 24-25,000. Nag down po ako ng 20k then sinisingil pa po ako ng additional na 5,500. Nung napasa po yung philhealth ko 24k po ang makuhang benefit. Pano po ba yun parang sobra na po ata yung naibigay ko. Walang wala na po talaga akong maidadagdag na 5,500. Ppwede po bang ako ang mag encash nung sa benefit para yung 5500 po ibigay ko sa st. Lukes then yung matira maibayad na sa inutangan namin ng pinang down?

    1. Hi Anelle, when they told you the 24k to 25k amount, did they ask if you have Philhealth? I asked because the 24k-25k payment might be in addition to Philhealth. Ask St Lukes about your billing and deduction.

  149. Good day po.. Ask ko lng po kung pwede kmi makapag refund sa philhealth kasi may binili kmi na gamot sa labas worth 111k (IV immunoglobulin) po un for may sick child.. Panu po ung process? Thank you po sa reply..

    1. Hi JR, under the new Case Rate scheme, the coverage for medicines and supplies are included in the fixed coverage for the illness or treatment done during hospitalization. So file your Philhealth documents during confinement/before discharge, and then ask your hospital when you can refund meds you bought outside (so you’ll know their Philhealth procedures and if there’s still allotment for part of the 111k you spent). You can also ask the hospital’s PCSO department to help you with documents to ask assistance from PCSO. It’s not that very difficult asking assistance from PCSO, especially for expensive medications/hospitalizations, and the amount of their assistance is really helpful.

  150. Hi po. Cervical cancer patient po ako sa jose reyes undego po ako sa radiotherapy at chemotheraphy marami po ako nabiling gmot for my chemo outside jose reyes. ask lang po if pwede ako maka-refund sa mga nabili kong gamot kare-recieve ko po today bpn ko anu po dapat ko gawin. thank u godbless

    1. Hi lhoidz, ask jose reyes how they process radiotherapy/chemotherapy claims. Coverage for 1 radiotherapy session is 3k (800 for pf; 2200 for hospital) and coverage for 1 chemo admin is 7,280 (1,680 pf; 5,600 hosp). I assume that the process will be that you submit your Philhealth docs, they deduct what they can deduct, and they file with Philhealth (no more direct filing with Philhealth), and then when Philhealth pays the hospital, you refund part of your expenses for meds, if your coverage is not used up for the hospital procedure. will email you the circular.

  151. hello po na operahan sa apindex ang anak ko nung jan.2 2014 july 9 na po hindi pa dumarating ang reimbursement . ask ko lang kung makukuha pa pa un.

    1. Hi whena, wait for your benefit payment notice from Philhealth via registered mail, or you can go to the Philhealth branch where you filed

  152. Hi! Na confine po yung anak ko last February, na cover naman po ng hmo ko yung 8k plus then 4,129 yung philhealth coverage. Kakadating lang po nung BPN today and ang binayaran ng philhealth sa hospital ay 15k. Entitled po ba ako sa refund? and if yes, san po ako mag file ng claim, sa hospital o philhealth? and pwede pa bo ba ako mag file ng claim kahit na last February pa na confine yung anak ko. Thanks.

    1. Hi Carmen, if you did not pay any amount to the hospital, you cannot claim a refund. You need an OR to claim a refund. It would be your HMO that can decide to claim their refund from the hospital because they paid the the hospital.

  153. Hello po. Aq po ung mismong member nang philhealth nanganak aq noongJan.5 dis yr tru CS.. until now wla pa yong refund q ncheck q sa philhealth branch dto smin na ok na at nkapagbayad na nang 19,000 noong june18 untl now wla pq nkukuhang refund and sa bill nmin nung pglabas nmin sa hosptl wlang ndeduct kasi cash out daw ang hosptl ngaun. Pwde po ba yun gnun cash out? As n wlang binawas khit piso sa bill nmin. Pls reply to my question .ty

    1. Hi carla, go back to your hospital with your bill and OR (keep orig copies for yourself) and ask for refund. You should also show your benefit payment notice (BPN) from Philhealth, but if you’ve not received it yet, you can try asking the hospital for refund, tell them Philhealth has told you that your claim was already paid.

  154. ung biyenan ko po naospital beneficiary sya ng mr ko na OFW. meron pong mga medicines na nabili kami from outside pharmacy at hindi na namin naibigay sa ospital ung mga resibo. pwede po ba yun irefund? thanks

    1. Hi jennifer, did you submit Philhealth papers to the hospital before discharge? If yes, wait for your benefit payment notice (BPN) and if Philhealth’s payment to the hospital is more than your Philhealth deduction, you can ask for refund for a portion of your purchases (bring ORs and your bill).

  155. Ask ko lang po kung mairereimburse pa po ba namin yung ginagastos namin sa pagpapagamot sa anak ko kahit out-patient lang po ang cgemotheraphy nya? Simula po kasi january 2014 out-patient na lang po ang treatment ng anak ko. Sana po matulungan nyo kami

    1. Hi Kelly, direct filing with Philhealth is no longer allowed. Find a hospital that performs outpatient chemotherapy (code 96408), 7,280 pesos coverage (1,680 pf and 5,600 hospital expense) with Philhealth coverage. Outpatient chemo is covered. One chemo cycle is equivalent to 2 days deduction from the 45-day allowance per year per member. You can also ask help from PCSO; the assistance is also significant. http://www.abs-cbnnews.com/current-affairs-programs/11/21/12/salamat-dok-how-seek-assistance-pcso

  156. hi there! just want to inquire something. na admit po kasi ako sa isang clinic, at first kasi akala ko UTI lang ung sakit ko. so they observed and admit me sa clinic/lying-in type na clinic. and base dun sa observation nila they assumed na sa appendix daw po yung problema. so they told me na magtransfer sa Hospital na talaga. upon my discharge dun sa clinic, di daw sila accredited ng philhealth pag dating sa case ko. un mga nanganganak lang daw ang counted sa kanila. so hindi ako naka avail ng benefits ko sa philhealth ko sa kanila and binayaran ko ng cash ung fee… may way ba para mareimburse ko sa philhealth ung nagastos namin? thanks!!!

    1. Hi vaal, sorry you can not refund. It’s true that lying-in clinics can only be Philhealth-accredited for maternity cases. Additionally, direct filing with Philhealth is no longer allowed. They should have told you immediately to go to a hospital, unless you insisted on getting treated by them.

  157. hello po.. i received po ung philhealth cheque with mispelled surname po ng husband ko. di ko po ma-ideposit ang cheque. anu po ang gagawin ko?

    1. Hi fadz, your husband should write a letter to Philhealth requesting for check replacement due to mispelling of surname. He includes a copy of his ID and a copy of hospital bill in the letter.

  158. Hi! Gusto ko lang sana malaman if possible pa bang mgreimburse ako ng medicines after ako madischArge.. We decided to sign a waiver kasi lumalaki na ang bill namin sa hospital..

  159. Hello,
    My HMO allows reimbursement for out patient meds that are part of the formulary list. However some meds that are prescribed were not part of it. The medicine is Abound and it was prescribed after successfully removing the mass that was diagnosed Stage 2 cancer on my Mom’s Left Breast. I was wondering if Philhealth can reimburse it and need to know how if possible.

  160. hi po,magkano po ba covered ng fistula operation?makakuha po ba ako ng reinbursement?yung mga resibo ko po kc halos 15,000 po yung nka attach sa philhealth ko ko nung na confine po ako..thanks po

    1. Hi Sheryll, Surgical treatment of anal fistula — 12,120 (5,400 hospital cost; 6,720 PF)
      Closure of anal fistula with rectal advancement flap — 18,000 (9,600 hospital cost; 8,400 PF)
      More complicated fistula operations range from 23 to 30k. Wait for your benefit payment notice so you can see the coverage

  161. hello po good day po…
    problem ko po is nanganak po asawa ko last august 4 sa TONDO gen and medical center sa BALUT TONDO MANILA..

    My philhealth po talaga ako. nilalakad ko po bago manganak asawa ko.. bale naging kulang yung requirements ko sa philhealth na CF1.

    Tinanong ko po ung sa billing tungkol sa philhealth ko at ang sabi is kailangan ko daw malakad yon dahil WALA NA DAW LATE FILLING SA PHILHEALTH.
    feeling ko ho niloloko lang ako ng tauhan nila..

    marerefund ko pa po ba ung binayad ko sa ospital? at ano po ba ang need ko kung sakaling makapag refund po ako thx

    1. Hi timbang, it’s true that members can no longer file their claim directly at a Philhealth branch. You should have submitted your employer-signed CF1 to the hospital before discharge. Ask others too.

  162. Hello po.. nakarecieve ako ng notice galing philhealth through mail. Nalagay duon na 30,300 ang amount na dapat kong mareimburse sa cebu perpetual hospital. At nung nakuha ko na ang check bakit po 13,500 nalang? Anu ba ang nangyari? When i try to call mis sheryl na kausap ko sa phone before ko makuha ang check ayaw na pong magresponse!
    Paki explain naman po at ayusin ang dapat ayusin..

    1. Hi rae, does this mean that you paid 30,300 or more to the hospital? If yes, you must make follow-up with your bill and OR. Keep copies for yourself.

    2. hi Rae! we almost had same case. anu ngyari na sau? were you able to get the difference? kc ung sa tatay ko ang sabi sa BPN P9,0000 ang refund pero P6,100 lng binalik samin ng hospital. ngcash out kmi sa knila before idischarge father ko. after pa kmi nagfile ng reimbursement.

    3. mejo vague ata ang policy ng Philhealth according to the hospital. ung sa tatay ko kc stated sa BPN P9,0000 pero P6,100 lng binalik samin ng hospital because of withholding tax or professional fees dw which from my understanding eh kasama na sa cashed out nmin before he was discharged. after makalabas cia saka pa kmi nagfile ng reimbursement bec we thought hindi pa pede gamitin ulit ang Philhealth nia.

      1. Hi zel, sad to say, some hospitals don’t deduct or refund the doctor’s fee allocation, which is 70% of case rate amount, if medical case, and instead give this as additional payment to the doctor.

  163. Ask lang po. Ang husband ko na confine sa Chong Hua Hospital (ICU) last March 29, 2014 at na discharge kami last April 28, 2014. Ang na deduct sa aming bill ay 36000. May matatanggap pa kaming refund since ang nabayaran namin sa hospital ay 400,000 sa hospital at 3000,000 sa doctor at hindi kasali ang mga gamot dahil hindi na charge sa hospital?

  164. hi ask ko lng naoperahan po un father ko last june 2009 after 1 year may nrecieved po kame n letter. hindi ko xa mxado inintindi kse busy po ako s work nun. akala ko dn kse may utang p kme s philhealth. now ko lng po nrealized n bka refund po un? gnmit po kse ng father ko un philhealth, san po ako pede mag inquire regarding po dun? posible po b refund po un? nttndaan ko po is may 10k and pupunta po ako s ph calamba. kindly reply tnx :)

  165. ASK KO LANG IF AFTER CONFINEMENT CONTINUOUS ANG INTAKE NG MEDICINE AND LAB TEST, PWEDE BA ITO MAREIMBURSE SA PHILHEALTH?

  166. ndi bnigyan ng any form ung Asawa q galing hospital tanging resibo lng.sa philhealth office nlg daw humingi.nung pnapnta q ung Asawa q sa isa sa Mga branch nyo po bkit ang sbi ala n raw reimbursement? so anu un no need n mgpasa kc dpt nsa hospital plng dpt naasikaso n namin? kung alam q lng n wala ng direct filling after hospitalize edi sana pnaghintay qnlg cla kht aabotin ng 5 days confinement anak q mhintay lng ung documents na galing dito sakin sa qatar.naicp kc nmn Lalo mgtagal Lalo lalaki ang bayarin.. more than 10,000 bnyad nmin akala q kung mgpasa sainyo kht ilang buwan pa ang hintayin bxta my ma claim kami kso anu po un? wala na o may pag asa pa? anu po needed gawin at anu ang requirements kung pwd pa o may pag asa pa salamat

  167. ndi q po kc na avail ung outright or automatic deduction due to andito aq now sa qatar.naconfine anak q.need ng hospital ng updated MDR q.how to get kylangan pa ng authorization letter q id at resibo n byad ng agency q ung philhealth q for 1 year.updated xa 6 mos. plng nmn aq dito.den nalaman q sa LBC dito 4-5 days p bgo mkarating sa pinas ang docs q.since ok na anak q 3 days confinement hindi n nla naantay ang docs q sb q cge may direct filling nmn.Pero bat po gnun how TRUE na ala n reimbursement? anu ung circular no. 35 ng philhealth? sana nmn meron p kc malaki din ngastos q.kung possible. pa what to do pra makapasa pa kmi? any idea po thanks panay contact n aq sa philhealth walang sagot.I have no idea about new system nla kung meron nga tlg.thanks po

    1. Hi luisamaria, yes, there’s no more direct filing with Philhealth. But your wife can update your Philhealth records and then take the chance of filing a claim with Philhealth with a letter of appeal explaining your situation and why the hospital did not make Philhealth deductions. I’m not sure if Philhealth will approve your appeal, but if you like, your wife can take the chance.

  168. hi gudam po. dependent po ako ng hubby ko s phealth nya. ask ko lng po if pede po b kmi direct file for philhealth reimbursemnt s office nila instead of direct deduction s billing po ng hospital.. kc im due for cs dis december kc po pg direct deduct po s hospital ang liit lng po ng amount. unlike po pg direct reimburse po b s office ng phealth mas mlaki po b mkukuha n reimbursement?

    1. Hi joy, direct filing by patient with Philhealth is no longer allowed. Ask your hospital why the 19k coverage for CS is not being deducted in full amount.

  169. Hi ask ko lang last August 9 my bf undergone ESWL (shock wave for her kidney stone) we used his HMO card and was asked for a philhealth CF1 form. upon discharge after we gave the philhealth form to their billing dept and was released already. Based sa nakasulat dun sa statement of account yung philhealth portion is 9600 pesos then 36,000 is deducted from HMO. We didn’t pay anything, does it mean wala kaming pede irefund since settled lahat?thanks

  170. hi po, ask lang po ako,nanganak po ako this august 18,2014 and i am a dependent of my husband po and he’s a seaferer.pwede pa po ba ma refund namin, yung deductiion sa philhealth? hindi po ksi na deduct yun sa bill na worth 20,599, ng huspital sa pag discarge namin kasi po,my form po na kailangan e fill-up at epadala sa office ng husband ko. kasu sa manila po yung office nya at nasa leyte po kami. wala po kasing mka process non kasi onbord pa po yung husband ko, so nag decide nalang po kami na mag discharge agad after 24 hours of admission. hindi po kasama sa 20k na bill yung newborn package ng baby ko, pwede pa po ba namin yun ma pa refund? sayang po kasi ehh…

    1. Hi ikha, sad to say, Philhealth no longer allows direct filing by members with Philhealth. But you can file an appeal and explain your situation. Ask the hospital to help you with the Philhealth papers.

  171. Hello po!ask ko lang po. Naoperahan po ako last aug. 13, 2014 sa bone tumor. Hindi po ako nakaprocess ng reimbursement at hindi rin nadeduct sa hospital bills ko. Pwede po ba ngayon ako magprocess eh last aug 19, 2014 pa po ako na discharged sa hospital. Ano po ba gagawin ko at saan ako pupunta? Please i really need ur help. Thank u so much and more power!God Bless!

    1. Hi Jevamie, sad to say, Philhealth no longer allows direct filing by members. You should have given your docs to the hospital for bill deduction. If you like you can file an appeal with Philhealth, and file the required claim docs. But I’m not sure if Philhealth accepts/approves your claim.

      1. Good Day, can we refund further from Philhealth? My child was confined for 5 days (Dengue stage 1). We were billed 35,000.00 and we filed as Philhealth(Indigent) and we got a deduction of 10.000.00. we paid 19 thou plus. Thanks, God Bless!

        1. Hi Rizza, the benefit for dengue stage 1 is 10k, and as you said, it was deducted, so there’s no more further refund. But you can still check how much Philhealth will pay the hospital when you receive your benefit payment notice from philhealth.

  172. hi! i paid philhealth from 2008 to 2011. never used it. can’t i get anything from my payments from 2008-2011?

    1. Hi rosalie, you can no longer use those past payments. Only when you turn 60 years old and you apply for Lifetime Free ID (must have paid at least 120 premiums). Philhealth is a hospitalization insurance with a social component — if not used during the periods paid for, we thank God we were healthy, and that we helped pay for others who needed to be hospitalized.

  173. Hi, how can we reimburse the medicines we bought outside the hospital? Patient discharged last friday Sept. 12, 2014. We did not pay anything because the case was covered by Philhealth. We have receipts. Can we reimburse from philhealth? Pls. inform us what we need to do. Thanks

  174. Hello. Need clarfication. I have BPN and expected to be reimbursed for med receipts. Paid my other meds for my caesarian. My bill was 14k plus. Is it possible for me to refund for my other expenses?

    1. Hi Ruthie, how much was deducted from your bill? 11,400 is Philhealth’s coverage for hospital supplies and meds, so if this amount was not fully used by the hospital or if your Philhealth deduction for hospital expenses was lower than 11,400, then you can go to your hospital and ask for refund. Bring your BPN and meds OR (xerox them).

  175. Good Day! May I ask about philhealth, I got my notice from philhealth and saw that it paid the ospital 15,000.00 but the actual bill of the hospital was 4080 only. Can the patient refund the excess paid by philhealth? can we get the refund from the hpspital

    1. Hi gretchen, sad to say, the patient can not refund the excess. Is this a government hospital? Because the difference is a bit big.

  176. hi. i was admitted last aug.18-24 2014 and i used my HMO card, but my philhealth benefit of 10k was not deducted because i wasn’t able to process it, as it was a Sunday discharge, and the next day was a holiday. The hospital advised that we pay the 10k in cash and then refund later on. I’ve fixed my documents and have submitted them to the hospital. Can I refund my 10k? and when can i get the refund? thanks. hoping for response. Godbless.

    1. Hi quennie, follow up with the hospital if they have filed your documents with Philhealth. It’s important that they submit your papers asap, within 60 days. It should have been a deduction, but Philhealth gives a leeway for employees discharged on non-business days. Keep your OR and hospital statement and bill. Xerox them. You can get your refund from the hospital after you receive your benefit payment notice from Philhealth, or you can call the hospital after 1 or 2 months.

  177. If I became a member just last month, and one of my child got hospitalized this month, would I be able to use my phil health benefits?

    1. Hi Joe, did you pay for the months of July to Sep? If yes, you cannot use Philhealth this month. In Oct, you can use it. Only OFWs, Sponsored or Lifetime members can use their Philhealth immediately after registration/payment.

  178. Hi what are the benefits that i can claim re: death benefits. Somebody’s deceased but philhealth was not processed. Can we ask for reimbursement for his medical and hospitalization? and what other benefit can we claim for this? Thanks

    1. Hi April, direct filing with Philhealth is no longer allowed. But you can file an appeal with Philhealth, if you like, and if you can get Philhealth documents from the hospital. Include patient’s death certificate — this will be your reasons why you were not able to file your papers with the hospital.

  179. Hi Nora! My wife got hospitalised last week for only a day and she got a bill of 15k +. I took care of my wife for a day, so i was not able to get the requirements for Philhealth reimbursement. Am i still able to get reimbursed if i submit the requirements within 60 days? TIA

    1. Hi Quentin, direct filing by patient with Philhealth is no longer allowed. The hospital should have advised you. But if you can get Philhealth documents from the hospital, and if you can prove to Philhealth that there’s no other person who can get your Philhealth docs that day, and that it was impossible for you to leave your wife that day, you can try making an appeal to Philhealth and file your claim. I can’t assure you though that Philhealth will approve your appeal. Ask others too

  180. hi, i have an endometrial ovarian cyst, i had medication for three months since june 2014. after 3 months continues medication for another 3 months. the meds are expensive. can is ask for reimbursement from philhealth? if ever, what’s the process?

    1. Hi beth, sad to say, Philhealth does not reimburse outpatient medicines; even expensive outpatient diagnostic procedures are not reimbursed.

  181. hi can i reimburse the vaccines used on my child who was bitten by a dog last sept. 17. the last shot was sept 25, 2014. we went to the ER because it was already nighttime.

  182. Hi can we reimburse if i deliver at the seamans hospital wherein we’re priveleged as dependents and we don’t pay anything, but they ask us to prepare our Philhealth papers.

    1. Hi Joy, no you cannot refund because you’ll not pay anything. The coverage is only 5k, so if you deliver in another hospital, you’ll pay the balance.

    1. Hi jolemy, sad to say, if CT scan is done as outpatient, it cannot be refunded. Starting May this year, Philhealth coverage should be deducted from the hospital; refund claim by member from Philhealth is no longer allowed.

  183. hi!! nag file po ako ng second appeal letter for my Philhealth claims.. i submitted it to there main branch office in Shaw boulevard..ang tanong ko lang po kung yong matatangap ko rin na reimbursemest is the same amount which i recently paid to the hospital? i paid a total of 31,915 fo hysterectomy operation.thanks and best regards.. i need your response very badly

  184. Hi our total expense for my child bitten by a dog was almost 8k, but the amount approved by san lazaro hospital was only 3800 . they didn’t approve our expenses for meds bought outside san lazaro hospital.

    1. Hi Llane, sad to say, Philhealth’s coverage for animal bite is only 3k. There must be something they did to add a deduction of 800.

  185. My child was confined at a hospital for 2 days due to pneumonia. The hospital is not accredited with philhealth. Can we reimburse with philhealth personally?

    1. Hi Maricel, sorry, direct filing with Philhealth is no longer allowed. Another thing is that the hospital should be Philhealth-accredited.

  186. Good day! Regarding the reimbursement of my baby. I gave birth last April 8, 2014 and filed the claim slip for my baby a month after. I received the BPN just last week (Oct. 11, 2014) but its under my name (5000) which I think deducted from the bill upon my discharge. Will there be another BPN for my baby that is refundable? Thank you. Will wait for the response.

  187. good day po!!..ask ko lng kung makakuha po ba kame ng refund sa Philhealth, na confined po kc yung father at na diagnosed ng stage3 gastric cancer, na operahan po cya. during discharge hindi po nabawasan yung bill namin sa Philhealth dahil kulang yung documents na kailangan ng hospital. Manila po kc yung employer,at hindi pa napadala yung CF1 na kailangan sa pag discharge. Pag ganito po bang sitwasyon may refund pa po ba kaming matatanggap?
    Salamat po and Godbless!!

    1. Hi Michelle, if you have the Philhealth documents, you can file an appeal to Philhealth, explaining the situation. But approval is not sure, as direct filing with Philhealth is no longer allowed. You can talk with the hospital about filing with them to get the refund.

  188. Good Day, my daughter was confined last oct. 11-13,2014,we submitted CF1 so we got meds from the pharmacy just signing because we have philhealth, but then when we got the hospital bill 6,972.57k, the doctor’s fee 3500. total of 10,472, the cashier said the case is not in manual (acute brocholitis) so we need to pay the total amount of 11,821.17.

    1. Hi julie, plead with the cashier to ask Philhealth if there’s another word for acute bronchiolitis. I searched the manual and there’s no broncholitis or bronchiolitis. If you’re forced to pay, if you decide so, you can ask the hospital to give you claim forms and medical papers so you can file an appeal at Philhealth.

  189. Hi Nora, My Dad received my BPN yesterday.. It was higher than my hospital bill. Could i still claim the difference since Philhealth will be going to pay that amount to them? Thank you po!

  190. Hi Girlie, did you pay an amount to the hospital? If none, you cannot claim. If you paid and you have OR, you can ask for refund.

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