Philhealth Deduction for Cesarean Section (CS)

Question: 

Why was my Philhealth Deduction for my Cesarean Section operation only 11,600 pesos?  Philhealth says my Case Rate coverage should be 19,000 pesos.

Answer: 

The coverage amount of 19,000 pesos for Cesarean Section is further allocated as:

11,600 pesos for hospital cost

7,400 pesos for professional fee (PF) or doctor’s fee

 

The hospital should deduct 11,600 pesos from hospital expenses

and should deduct 7,600 from the fees of the ob-gyne and the anesthesiologist.

What usually happens is that only the 11,600 pesos is deducted from the total hospital bill,

based on many comments on our blogs.

Why?

There are various reasons, also based on comments on our blogs:

.  The 7,600 coverage, when paid by Philhealth, will be given to the ob-gyne and/or the anesthesiologist as additional PF.

.  The 7,600 coverage is in addition to the PF agreed upon with the ob-gyne before the CS operation.  After all, the ob-gyne can quote any PF amount, as long as the patient agrees.

.  7,600 pesos is NOT CASH. It is to be paid by Philhealth months after filing. There might be reasons some doctors or hospitals do not deduct this 7,600 pesos from the bill.

.  “It’s common practice” daw.

.  The 7,600 pesos will be refunded when the hospital receives its reimbursement from Philhealth.

 

What you can do?

.  When you receive your benefit payment notice (BPN) from Philhealth, go to the hospital with a copy of your bill, payment OR, BPN and ID and refund your 7,600 pesos.

.  Ask to speak with the billing/collection/accounting manager or the head of the hospital.

.  File a complaint with Philhealth.  Bring supporting documents.

.  File a complaint with DOH. Bring supporting documents.

.  Write to newspapers, online news sites, etc. about your case.

.  Write about your case on the Facebook page of Philhealth.

 

Or you can just consider your 7,600 pesos as a gift or token of appreciation.

If the hospital says they have given your 7,600 as additional professional fee to your ob-gyne and anesthesiologist, and you were given excellent care by them, then just think your 7,600 is your token of appreciation for their service, especially if the cash that you paid them is not that much compared to the professional fees charged by other doctors for CS.

94 Comments

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  1. Ask regarding the philhealth of my husband who is a seaman ofw. His contract feb – nov. My tentative date for cs is in sept. Can I be covered by philhealth? Thanks

    1. Hi Ann, you can avail, make sure his agency is paying his Philhealth, at least June July Aug. Or to be sure, from Mar to Sep 2014.

      1. Kapag po sept ako manganak tapos po ang hulog ko sa philhlt ay jan to march at july to sept makakaavail po baako ng benefits kahit nalaktawan ko ang april- june.. tnx po vol member po ako

        1. Hi april, yes, your Mar, Jun and Jul payments should be the ones counted. http://www.healthphilippines.net/2014/06/philhealth-maternity-benefit-individual-payor/

  2. Hi! It’s my 3rd cs. Can I avail of philhealth coverage? I had 2 miscarriages and 2 cs and now this is my third CS. Thanks Days

    1. Hi Daisy, yes you can avail as long as CS is indicated by your ob. Find a Philhealth-accredited ob and hospital.

  3. Can I be a beneficiary of my husband? I’ll use it for my delivery. We’ve just gotten married and he’s in Saudi. His payments are updated when he was in the Phils. What’s the process? thanks Godbless 🙂

    1. Hi teresa, ask your husband to email you a copy of his OEC or Philhealth receipt and an authorization letter authorizing you to update his MDR and process all Philhealth papers. Then you go to Philhealth with your marriage cert (orig and xerox) and ID and update your husband’s MDR (write yourself as beneficiary). God bless too.

  4. Ask ko Lang Bakit ako natanggal na binificiary ng asawa ko active Philhealth member sya kumuha sya mdr nawala ako sa list help me po manganganak panaman ako thanks

    1. Hi nora, ask your husband to present your marriage certificate to Philhealth to update his MDR

  5. hi mam ask.q lng po ano mga requirements pra m avail ang philhealth? thanks

  6. Melody A. Lumingkit

    Hi po gudpm..!!dependent po ako,seaman po asawa ko.,naka Sampa po sya nung April 2014.,manganganak po ako this coming sept CS po.,makaka avail po ba ako as philhealth.?april to dec po ang hulog ng company nila..!

    1. Hi Melody, yes, get 2 sheets of signed claim form 1 (for you and your baby) and cert of premium payments from your husband’s company

  7. Hi po, nanganak po ang hipag ko today, na cs po sya, ngayon hindi po pala nila na renew yung philhealth nila, 2years na. Kapag po ba binayaran nya yung 2years na yun sa philhealth makaka avail pa rin po ba sila? Salamat po.

    1. Hi sally, sorry there are payment deadlines. Premium payment should be before hospitalization. Ask others too

  8. Hi I’m confused. I had cesarian delivery last march 28,2014. We paid 21k and we were not given a receipt. According to the hospital, they don’t issue receipts if discounts are given. My husband is a Philhealth member. Philhealth told us we should have been given the 19k coverage. We can no longer get back the 21k we spent. What we got were our papers for claim filing but Philhealth told us self-filing has been disallowed since January.

    1. Hi dette, sad to know of your situation. Thanks for sharing. I hope others will learn from your experience. Philhealth should have done more to inform their members of their policy change in claim filing. If you like, you can post your comment on the Facebook page of Philhealth.

  9. hi ask ko lang sponsored po ako ng brgy. for 1year (jan.-dec. 2014)
    and manganganak ako sa november, may possible daw na ma c.s. privte po yung panganganakan ko. okey lang po ba yun kahit wala nmn ako hulog at mag kanu po ba ang covered ng philhealth pag CS at NSD.?

    1. Hi catherine, if you have your sponsored Philhealth card in your name and the validity dates Jan to Dec 2014, then you will be covered. Get your MDR from Philhealth. IF CS, it should be in a hospital, and the decision on whether it’s CS or normal should be decided by the ob-gyne, so you’ll be covered. Find a hospital that offers lower rates for CS, so you don’t have to pay a big balance.

  10. Hi Ms. Nora, does a spouse’s dependent get the same benefits from philhealth as those received by an individual payor? Thanks

    1. Hi Jennylen, yes, dependents and members and different types of members get the same benefits from Philhealth

  11. hi there! i just want to ask with regards on the cs delivery with tubal ligation at the same time. How to avail the 50% discount for the tubal ligation? coz ive heard that there is a 1st case and 2nd case basis for this, so discount can be availed. kindly please give me a feedback as soon as possible. thanks and more power

    1. Hi Erika, tubal ligation can be covered as second case. But there’s a circular that says the coverage for CS is 19k, whether it is with or without tubal ligation.

      1. Maam, my edd is dec 2014, i paid for the m0nths of april-sept 2014, can i avail of my benefits? Tnx.

        1. Hi Arra, yes, you can avail. But pay for Oct to Nov or Dec, to avoid further questions by stricter hospitals. http://www.healthphilippines.net/2014/06/philhealth-maternity-benefit-individual-payor/

  12. Hi ma’am. Had cs last april 2014. my hospital bill is 16k and professional fees 7600 total 23k+. can i get a refund? Just asking.thank you

    1. Hi ireen, did you file your Philhealth with the hospital? How much was your deduction? If your Philhealth deduction was 19k, you have received your full benefit and there’s no more refund.

  13. Hi. Im currently pregnant and will deliver by january through 3rd cs. My last payment was from January to June 2014. But for almost 4 years I paid philhealth. I’m unemployed since last June 2014. Can I still avail my philhealth? Thanks.

    1. Hi Lourdes, you should pay asap for Oct Nov Dec 2014 so you can avail in Jan 2015.

  14. Hi ma’am good evening, I haven’t paid Philhealth for more than a year. I want to pay because march is my sched for cs. can I still avail?

    1. Hi Nissa, pay asap for Oct Nov Dec 2014, and then for Jan to Feb 2015. Xerox your receipts.

  15. Hi. can i file a late maternity claim for my delivery last year november11, 2013. ceasarian section, public hospital. My company said they’ll file but they have not filed. I spent 11,000 for meds/supplies bought outside the hospital. The hospital said my company did not file. Can I claim what I spent? Thanks.

    1. Hi Stella, sorry, you’re already late. Filing period is within 60 days after discharge. Also, since Jan 2014, direct filing by member with Philhealth is no longer allowed. Before you were discharged, you should have asked for a claim form 1 and cert of premium payment from your company and filed these 2 docs with the hospital before discharge

  16. Hi! Ask about my phil health. I’m Ofw and I’m giving birth in pilipinas. I paid for 1 year to philhealth. Can I use it this coming december 2014? I’ll be having CS and I’m worried about hospital costs. I’ll use Philhealth for the first time. Do you have any idea how much I can avail from philhealth? bikini session is the style of my cs? Thank you and Godbless!

    1. Hi Whenzy, is your MDR or receipt says you’re OFW? Do your premium receipt dates cover Dec 2014? If yes, then you can avail in Dec. The coverage for CS is 19k pesos. But talk with your doctor about total cost and if 19k will be deducted, so you can prepare. There are doctors that you have to pay much, from 30k to 50k and upwards, even after the 19k is deducted.

  17. Hi Ms. Nora. I was employed from june-nov2013. After that, did not update philhealth. But oct. this yr I changed to voluntary then paid 600php. Im 37wks pregnant and my due date is on jan. Ths is my 2nd and cs. can i use philhealth? Thank you

    1. Hi Rea, yes, you can avail in Jan. Ask your hospital/ob-gyne about their Philhealth policy.

  18. I am not aware about this just until now that I’ve read and came across this forum. I really want to ask why it was only 11k deducted only from the hospital bill. It’s been 1 year and 9 mos already and we will be having our second baby on the expected month of Feb 2015. Can we still ask for a refund for the 7,6k? Because I remember we paid complete cash for the PF.

    1. Hi Gab, 7.6k should have been deducted, but sorry I’m not sure if you can still refund it as it’s been nearly 2 years. They’ll most likely say the 7.6k was additional to the PF. But you can ask the hospital, if you decide so.

  19. Hi, last payment to philhealth was 2012,then i updated july 2014 and paid July -dec 2014. can i use philhealth for my delivery this feb2015?

    1. Hi rose, yes, you can use Philhealth in Feb. http://www.healthphilippines.net/2014/06/philhealth-maternity-benefit-individual-payor/ If you can, pay also Jan to Mar 2015 in Jan 2015

  20. Hi! if philhealth membership is activated this January, can i avail next month due to give birth by cs?

    1. Hi Joyce, if you paid Jan to March but did not pay Oct to Dec, sad to say, you might not be able to avail in Feb. If you give birth in Mar, yes, you can avail. Ask others too.

  21. hi my wife registered as member in july 2014. she paid july-sept. she didn’t pay oct-dec. what can we do to avail of benefits? Her CS is next week. Thanks

    1. Hi billy, sad to say, the payment deadline for Oct to Dec 2014, which is required to be paid, is Dec 31, 2014. Ask others too

  22. Update ko lang po, thanks sa philhealth, binayaran lang namin yung buong 1year na contribution for 2015 at na avail namin yung 11,900 na benifits. from 12,900 na bill naging 1k na lang binayaran namin. Thanks philhealth ang laking tulong nyo po.

  23. Hi ms can i avail of philhealth benefits for cs delivery. i paid oct. To dec. 2014 and jan. To march 2015 duedate is feb. 6. 2015

    1. Hi Laarnie, yes, you can avail.

  24. Can I be covered by philhealth. june is my due date. I paid for 1yr to philhealth. thanks

    1. Hi rizielle, do you mean you paid Jan to Dec 2015? If yes, you are covered. If you paid for April to June, yes you can use it in June.

  25. hi miss nora can I still refund what I spent for my cs section for my 1st baby last dec 2014. my bills reached 31k but what we refunded was only the newborn sreening for my baby which was 600. I don’t know what to do. thanks

    1. Hi Beatriz, do you mean there was no 19k deduction in your bill? Check your bill if there’s Philhealth deduction. I’m puzzled that only the newborn benefit was reimbursed. Wait for your benefit payment notice from Philhealth. Check how much Philhealth paid to the hospital, and ask the hospital for refund if there’s discrepancy. Keep and xerox your receipts and documents.

  26. Hi my due is on last week of march 2015 for CS delivery i have paid oct-dec 2014 and jan-march2015 how much discount to avail for CS. My doctor told me it will cost me 70k hoping for a bigger amount to avail.. And if ever what to bring on the big day? Just my philhealth id and xerox receipts? Thank you!

    1. Hi Paupau, coverage is 19k (11400 for hospital cost and 7600 for PF). Documents required: MDR, premium receipt, ID, claim form 1

  27. mark anthony abuan ramos

    hello ms, how can my wife avail? She was active dec 2014. She’s due in july. I’m ofw. thank you

    1. Hi mark anthony, do you mean you were not able to pay your Philhealth as OFW? If not, your wife can pay asap for March to June or March to July at Philhealth so she can avail.

  28. hi! good noon. Is pf covered by philhealth if cs. is there excess cost that we need to pay?

    1. Hi trixie, you need to talk to the ob. Usually, Philhealth coverage is not enough. CS coverage is only 19k (11400 for hospital and 7600 for pf. Find a government hospital in which your Philhealth is enough. Ask for No Balance billing.

  29. Hello Nora,
    My cousin was already been discharged in the hospital a week ago, and CS as the operation to her was covered by the Philhealth but Doctor’s fee was not covered for she was considered a private doctor that time. In line with this, I would like to ask if the medicine brought outside the hospital can be refunded by the Philhealth? If yes, please advice what shall I do.
    Thank you.
    God bless.

    1. Hi karen, was 11,600 deducted from your cousin’s hospital bill? 11,600 is the total allocation for hospital expense. Now if this amount was not fully used, wait for the benefit payment notice from Philhealth via postal mail, then request for refund from the hospital (present notice, hospital docs and OR and your receipts of meds bought outside the hospital)

  30. Hi, Nora, my OB told me her package for my delivery is 25K if NORMAL, 35K if CS, can increase depending on my and my child’s condition. Philhealth is already included in the package. Please advice. How much really is the cost?

    1. Hi Anna, that’s your OB’s Philhealth package, so that’s her rate. Doctors can really dictate how much they want because hospital rates are not regulated by the government. Compared to others, her rate is reasonable. I know someone who gave birth via normal delivery at a small clinic and she paid 30k with Philhealth and that was in 2014. Take care.

  31. Hello po. Can i avail po of philhealth? I paid for April up to this month. Expected delivery in August

    1. Hi Phoebe, did you pay April to June? If yes, you can avail in August. To be sure, ask your hospital or clinic during your next check-up

  32. Crisanto villacruel

    Hi!..ask q lng po kc na c.s asawa q last week and they only deduct 8500 from my philhealth i ask them dpat 19k ang maibabawas ang reason po nila they were only primary hospital..marereinburse q po b ung kakulangan ng 19k sa philhealth?..thanks in advance

    1. Hi Crisanto, wait for your benefit payment notice from Philhealth via mail. You can see in your notice the amount paid by Philhealth to the hospital. If Philhealth paid 19k to the hospital, xerox your notice and hospital papers, and ask for refund from the hospital.

  33. Hi po, is it possible to have 2 philhealth account? I’m currently employed and my company is paying for my philhealth and at the same time my mom included me in her application for the free philhealth sponsored by the government in our province and sabi ni mama updated ang payment ko don kinuhanan na rin nya ako ng mdr. If yes po, can I get the same benefit kahit aling philhealth record ang gagamitin ko?
    My mom told me kase na yong pinsan ko who gave birth just this week cs sya ang her hospital bill was about 86k eh ang binayaran lang is 15k using the philhealth sponsored by the government. Pls help po I’m about to gave birth anytime kasebin a public hospital painless sana and as per my ob nasa 25k ang babayaran ko less philhealth na yon and that includes everything na parang package and if cs daw I will pay about 35k.
    Thank you

    1. Hi Hiedel, you can only use one Philhealth membership. Because you’re Employed, it’s your Employed membership which is your correct membership. Your sponsor does not know you have Philhealth — that’s why you were accepted into their program. Anyway, Philhealth benefit amounts are the same for all types of members for the same medical condition or treatment. Siguro ang advantage lang ng sponsored sa province ay isipin ng compassionate OB “ay sponsored ito, siguro bigyan ko ng discount”, but I’m not sure. CS coverage is only 19k, so I’m pleasantly surprised that your cousin got a deduction of 71k. Did the doctor give her a 52k discount? Is your province very far? You can ask for more info from your cousin. About your OB’s package, her rates are about average, based on rates mentioned by those commenting here. Philhealth’s coverage for normal delivery is only 5k.

  34. hi mrs nora ask ko lng po nahulog po kc nmin s philheatlh ay 1 yr. n po start jan to dec 2016 magagamit po b nmin un kpag nanganak n ung asawa ko c.s po xia pwde rin po b gamitin nmin ay dalawa philhealth khit ndi p po kasal .?? salamat po

    1. Hi darwin, dahil hindi kayo kasal, dapat ang Philhealth member ay si misis, your wife, so she can avail of Philhealth. Hindi mo siya puedeng dependent kasi wala pa kayong marriage cert na ma-present to Philhealth. About use of 2 Philhealth: Kapag pareho kayong merong Philhealth, hindi puedeng 2 Philhealth ang magamit, isa lang, even if you were married.

  35. Good day! Just want to ask because i’ll be having cs delivery this coming nov, is myomectomy will be considered as second case? If so, how much the coverage? Thanks!

    1. Hi Rose, sorry, wala sa list of second case rates ang myomectomy or CS. Coverage for abdominal myomectomy is 23,300 pag ito ay separate procedure. Ask your OB-gyne so you can prepare.

  36. Hi Ms Nora! I was planning to pay for June to dec.May I ask when is the deadline?I will be a surgery this sept or october.can I avail the benefits? Thank you

    1. Hi Lhian, the payment deadline for any quarter is the last day of the quarter. Yes, pay asap this month for July to Dec so you can use it in Sep or Oct. If your MDR is not updated or no longer clear, pay at Philhealth so you can get your new MDR.

  37. Hi ms. Nora.. magkano dapat contribution ko para maka avail ako sa 19k coverage ng philhealth..cs po ako sa 1st baby ko..and sa november na ang due ko..resigned na po ako since 2015..if i avail for this month of june until december, can i avail the amount of 19k for cs?thanks po..

    1. Hi Ayenna, pay for July to Sep ASAP — puede na ito for November, but pay also for Oct to Dec for continuous coverage. Yes, covered ang CS kung CS ang decision ng doctor.

  38. Hello po, manganganak po ako sa July 30 at active philhealth member po ako. If ever po normal delivery po ako may makukuha po ba akong deduction galing sa Philhealth at magkano po if sakali?

    1. Hi Melanie, 5k lang ang coverage for normal delivery sa hospital. 3k for hospital and 2k for the doctor. Most of the time pa, yong 3k lang and dinededuct.

  39. Hello po, ask ko lang kung covered pa po ako ng philhealth? 4 babies via NSD tapos ngayon po sa April manganganak ako pero sabi po ng OB CS kase may chronic hypertension ako.

    1. Hi ruth, oo maco-cover ka. Tinanggal na nila yong limit na 4 normal deliveries. Pag CS, hindi binibilang noon pa. Para sure, ask mo yong billing dept. ng hospital next time magpa-chekup ka.

  40. Hello po good morning ask ko lang na cs poh anak ko now .2/16/2018 Hindi pa kasal .diyan sarah mother care poh.magkano poh babayaran namin ..

    1. Hi Rowena, ang Sarah Mother Care ba ay name of clinic? Tanungin nio po ngayon na sa Billing section nila kung magkano ang babayaran nio. Ang deduction is 19k, pero ang actual na madeduct doon sa PF portion (7400) ay depende sa doctor at sa clinic.

  41. Hello po..due ko po kasi ng april 5 2018 magkano po kaya ang macocovered sa philhealth ko..kasi pina pa schedule nya ako for cs kasi suhi daw si baby..since employed naman po ako since 2015 upto present.magkano po kaya ang babayaran ko

    1. Hi Joy, I don’t know kung babalikan mo pa itong tanong mo. ang coverage for CS is 19k (11,400 for hospital and 7,600 for doctor). Tanungin mo ang OB mo kung magkano ang babayaran mo kung meron kang Philhealth, so you can prepare. Kung meron siyang sabihin amount, ask mo “lahat na po yon, pati hospital po?”

  42. Hi po, im a voluntary member since unemployed npo ako for 2 yrs. Kakaupdate ko lang po ng philhealth ko last month. My due date is supposedly on May this yr. under ceasarian section. Pinagbayad po ako ng philhealth s bayad center for the month of jan to june 2018, i paid last march 15 kaya lang po napaaga ang due date ko. The big day will be on April 15, 2018 instead of May, can i still be covered? Thanks po

    1. Hi Ivy, yes, covered ang April delivery mo, buti na lang nakabayad ka last month ng for Jan to March.

  43. Hi po mam nora ask q lng poh cs ang asawa q kng my 19k benefits poh sya makukuha s philhealth bkt kme poh ang bumibili ng gamot kme nag bayad ng laboratory pti hospital bill db db dpt m less n agad un? My refund p poh b kme makukuha nun.. Matagl n poh member ng philhealth wife q at s goverment hospital lng poh sya n nganak..

    1. Hi Macky, nag-submit kayo ng Philhealth papers sa hospital? Tinanggap? Dapat merong deduction na 11,400 (hospital costs). Yong 7,600 na for PF, hindi na dinededuct kung libre ang mga doctors. Kung walang deduction, ipunin ang mga receipts para maka-refund later on from the hospital. Kung walang budget ang government hospital, ganyan ang practice. At nagrerefund na lang kapag natanggap na yong payment from Philhealth.

  44. good day, ask ko lang po sa aug po ang due date ko anong month po ang need ko na mahulugan para maavail ko po ang maternity benefits sa philhealth, unemployed na po ako since 2016 at magkano po ang monthly na huhulugan ko sa pag update? thank you and GODBLESS.

    1. Hi Jen, pay asap for Apr to June, and then in July, pay for July to Sept. Puede ring bayaran mo na agad ang Apr to Sept.

  45. ask ko lang po ng start po ako mg member sa philhealth noong oct-dec 2017.tapos hindi ko po nabayaran iyong month of jan-march tapos po babayaran ko po sana yon kaso may diedline daw po bali nabayaran ko lang po is april-dec 2018;manganganak po ako ngayon may by cs kaya kailangan ko po maka discount, makaka avail pa rin po ba ako kahit jan-april diko po nabayaran? pano po ba gagawin ko? thank you

    1. Hi aslima, yes, you can avail. Use your Dec 2017, April May 2018 as your compliance to the 3 months within 6 months payment requirement. Ask mo yong hospital in your next checkup para sure at para hindi ka stressed.

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