PhilHealth lauded for extension of dialysis coverage
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CEBU CITY, Philippines — The Cebu Provincial Board lauded the Philippine Health Insurance Corp. (PhilHealth) for allowing its members listed in its Chronic Kidney Disease Stage 5 (CKD 5) database to avail themselves until the end of 2022, a maximum of 144 hemodialysis sessions from 90 sessions.
In a statement, the state health insurer said that the provincial board acknowledged that such a measure would be a “great advantage” for its PhilHealth CKD 5 registered members as it would ease their economic burden.
“Hemodialysis treatment per session costs quite a bundle of money which is why many, especially among the marginalized, are at wits’ end and are trying to scrounge sources of funds to be able to meet the prescribed treatment schedules with the number of sessions required,” PhilHealth said quoting an excerpt from the minutes of the Provincial Board’s 5th regular session.
Each member of PhilHealth is generally only eligible to a maximum of 45 days of coverage per calendar year, with an additional 45 days to be shared among all dependents.
In 2015, PhilHealth, through Circular No. 22 and 24, expanded the coverage for hemodialysis from 45 to 90 sessions per year in order to help lessen the financial burden of members undergoing such procedure. The additional outpatient dialysis sessions after the exhaustion of the regular 45-day benefit limit were derived from the unused benefit allotted for the principal member, if the patient is a dependent; or the allotted 45 days to be shared by all the dependents, if the patient is the principal member, within the calendar year.
In August 2022, PhilHealth released Circular No. 2022-0017 increasing the coverage of (CKD) patients registered in the PhilHealth Dialysis Database allowing them to avail of the maximum 144 hemodialysis sessions until Dec. 31, 2022, provided that the dialysis sessions had been prescribed by their attending physicians.
Earlier, the coverage of CKD 5 patients was also extended to 144 sessions at the height of the COVID-19 pandemic through Circular Nos. 2021-0002 and 2021-0009.
According to PhilHealth 7 data, hemodialysis had the highest number of submitted claims among the covered procedures in 2021, with benefit payouts of P358 million. The Regional Office has paid roughly P146 million for claims related to hemodialysis as of August this year.
Over 2,000 CKD patients in Central Visayas were registered in the PhilHealth Dialysis Database from 2021 until August 2022.
Coverage for hemodialysis may be availed at PhilHealth-accredited Health Care Institutions (HCI) nationwide, such as hospitals and dialysis clinics. Currently, 55 accredited HCIs in the region are providing hemodialysis procedures. A total of 22 of them are dialysis clinics located in Cebu.
Aside from hemodialysis, PhilHealth also has coverage for peritoneal dialysis or “PD First” worth P270,000 per year, and for kidney transplantation worth P600,000 under the Z Benefit package, which may be availed in contracted hospitals.
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