Low Risk Pneumonia — Not Covered by Philhealth

Low Risk Pneumonia is not covered by Philhealth.

This is based on experiences of  some patients who have commented on this blog and on Philhealth Circular No. 020, s-2011, signed on November 21, 2011 and Circular No. 011-A-2011,  signed August 5, 2011

This means that there’s a chance that your hospitalization due to pneumonia might not be covered by Philhealth if your x-ray shows that your pneumonia is not that serious.

Palagay ko sabi ng Philhealth dapat ay sa bahay na lang ginamot at hindi na kelangang i-confine.

What types of pneumonia are covered by Philhealth?

Moderate-Risk and High-Risk Pneumonia are covered.

What are the symptoms and signs of Moderate-Risk Pneumonia?

For Adults:

- Unstable vital signs (breaths, heartbeats and temperature)
- Extra pulmonary sepsis
- Suspected aspiration
- Presence of other illnesses, such as:
uncontrolled diabetes mellitus
unstable coronary artery disease
congestive heart failure Class II-IV
renal failure on dialysis
progressive neurologic disease
chronic obstructive pulmonary disease
liver disease
active malignancies

For children, up to 18 years old

- Moderate dehydration
- Inability to feed
- Increased respiratory rate
- Signs of respiratory failure
- Complications such as pneumothorax, effusion, etc.

Note:  Chest x-ray result is included in the claim documents.

 

Signs and Symptoms of High-Risk Pneumonia

- Signs and symptoms of moderate-risk pneumonia, plus the following:

- Shock

- Signs of hypoperfusion, such as:
hypotension
altered mental state
hypoxia
acute hypercapnia

- Urine output is less than 30 ml per hour

Note:  Diagnostic test or chest x-ray result is included in the claim documents.

 

So what does these things mean about Philhealth and your hospital bill?

Be prepared to pay your whole hospital bill,  without any Philhealth deduction, kung yong pneumonia mo ay hindi pala serious na pneumonia, at puede palang gamutin lang sa bahay with strong antibiotics.

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