Philhealth Deduction Problem at Government Hospitals


There are lots of questions about Philhealth deduction at government hospitals,

and I cannot answer them all.

so I’ll try to give a common answer here that I hope can cover most questions:

First, you can no longer file your claim directly at a Philhealth branch.

You can no longer claim your refund from Philhealth after discharge.

There are only few exceptions, such as overseas confinement.

So, you must inquire about the hospital’s Philhealth processing upon admission,

and file your Philhealth papers with the hospital ASAP.

The correct processing is that your Philhealth benefit is fully DEDUCTED from your hospital bill, you pay the balance, and then you go home.


So what they do is give you prescriptions and then YOU BUY medicines and supplies from drugstores outside the hospital.

When you see your hospital bill, you will see your Philhealth deduction. Usually, there’s a balance that you need to pay.

In some cases, everything is paid for by Philhealth, and you will not pay anything.

How about the medicines and supplies you bought outside the hospital? There are times the amount is even bigger than your hospital bill?

How will you refund the money?

Or can you still refund the money?

You can refund the money or some of the money from the hospital

after several months

only if Philhealth will pay the hospital more than what was deducted from your hospital bill.

You can see this amount when you receive your BENEFIT PAYMENT NOTICE (BPN) from Philhealth after several months.

Or you can ask the hospital.

Or if you know the diagnosis or treatment, you can check Case Rate lists at or other health sites.


Example 1:

Diagnosis is Pneumonia (Moderate Risk).

The Philhealth benefit for this is 15,000 pesos

(10,500 pesos for hospital expenses, medicines and supplies and 4,500 pesos for doctors’ fees).

You bought 3,000 pesos worth of medicines and supplies outside the hospital.

Your hospital bill is 7,000 pesos. You were not asked to pay anything…because the 10,500 allocation is more than enough to pay this 7,000 pesos.

How about the 3,000 pesos you spent?

You still have available allocation (10,500 pesos – 7,000 pesos = 3,500 pesos).

Keep your prescriptions, ORs,  and your hospital bill, and when you receive your BPN, return to the hospital and request for your refund.

ORs must be in the name of the patient. Xerox your documents.


Example 2:

Procedure done is Cesarean Section (CS).

Philhealth benefit for CS is 19,000 pesos

(11,400 pesos for hospital costs and 7,600 pesos for doctors’ fees)

You bought 9,000 pesos worth of supplies and medicines outside the hospital.

Your hospital bill is 14,400 pesos. You paid 3,000 pesos (14,400 pesos – 11,400 pesos = 3,000 pesos).

What about the 9,000 pesos you spent?

Sad to say, the allocation of 11,400 pesos has been fully used up.  So you can no longer refund your 9,000 pesos.

12 thoughts on “Philhealth Deduction Problem at Government Hospitals”

    • Hi sey, what I see on the Case Rate list is transient neutropenia — 7800 (2340 for PF and 5460 for hospital expense). For cyclic or periodic or toxic or congenital neutropenia — 12,100 (3,630 for PF and 8470 for hospital expense).

    • Hi karen, wait for your notice from philhealth. Maybe 3 to 6 months. Did you file your claim with Philhealth? Was your claim accepted? The hospital should have deducted your benefit from your bill.

  1. Hi, my daughter was confined due to pneumonia, but only the 10500 hospital bill was deducted from our bill, and the deduction for pf is 0..when I asked the clerk why, she only said “ma’am net of philhealth po kami”.

    • Hi dhes, sad to say, many are doing that. You can file a complaint with Philhealth, but I think it’s not a wise fight as PF is not regulated. Doctors can charge any rate that they want. The reason could also the that doctors want cash in full; they can’t wait for Philhealth. Ask the clerk if you can ask for PF refund after Philhealth has paid the hospital.

  2. Good day, what are the monthly contributions of Z package? Can my children and grandchildren avail of Z package? I’m Philhealth member and interested Z package.
    Waiting your reply soon. Rena

    • Hi Rena, if you’re an individual payor, monthly contribution is 200 pesos. You must be updated with your payments. Children can be dependents only if they’re younger than 21. Grandchildren can’t be dependents. Each Z package has its separate requirements with regards to the stage of the illness and other criteria

  3. Good day Nora! for example the hospital cost under cesarean delivery is only 5,800 (less than 11,400) and the professional fee is about 15,000 (which is more than the 7,600 allocated benefit for PF) does this mean that i wont be able to maximize the full benefit of 19,000 and i still need to pay the excess of 7,400 Prof Fee? is it by any chance applicable to submit my Doctor’s PF official receipt as my proof to request for refund (atleast 5,600 from 11,400-5,800=5,600)after i will be able to receive my BPN? or the 19,000 will be automatically deducted from the total hospital bill irregardless if its hospital cost or professional fee?

    • Hi Rose, you are right in your first assumption — the deduction will be according to the PF and hospital cost allocation. You’ll pay the balance of your PF even if you still have unused amount in your hospital cost allocation. There are also many cases that the PF quoted by the OB is the cash amount you pay to the OB and that the 7600 Philhealth benefit is an additional PF that will be given to the OB or to the hospital doctors’ pool. So ask your OB so you can prepare.

  4. Hi Nora, I’m 65 year old and doctor has to do total abdomen hysterectomy because of my endometrioid carcinoma, I just want to know if I can use the Z package for the surgery? or is it only for radiation and chemo?

    • Hi basilisa, sorry there’s no Z package for endometrial carcinoma or for hysterectomy. The regular coverage for total hysterectomy is 30,000 (12k for PF and 18k for hospital costs). There’s also 7,280 for chemo administration. Radiotherapy’s coverage is 3k. Coverages for chemo and radiotherapy are reduced if they’re performed together with the main treatment.


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