PhilHealth now covers readmissions for same illness within 90 days

Members, who are readmitted due to the same illness in a span of 90 days, can now avail of PhilHealth benefits after the state health insurer lifted its Single Period of Confinement policy beginning October 1, 2024.

This applies to medical conditions and surgical procedures under the All Case Rate payment scheme.

The Single Period of Confinement Rule is a policy developed during the Philippine Medicare era which imposes that admissions and readmissions due to the same illness or procedure within a 90-calendar day period shall only be compensated once. This has resulted to members paying for the entire hospitalization and caused denial of claims on the side of health facilities.

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“After extensive evaluation, we have lifted the rule of Single Period of Confinement to ensure continuous coverage for patients with recurring conditions,” said PhilHealth Chief Emmanuel R. Ledesma, Jr. during a recent media forum.

“This move also shows our strong commitment to fulfill our mandate — to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all Filipinos,” he added.

Recurring illnesses

The lifting of the policy was well-received by healthcare providers and members.

“Napakalaking epekto ang pag-alis ng SPC dahil karamihan sa pasyente namin ay recurring ang sakit gaya ng pneumonia at Chronic Obstructive Pulmonary Disease. Hindi naman natin puwedeng tanggihan ang pasyente dahil kailangan silang ma-treat dahil marami talagang pasyente ang may recurring sickness,” said Ma. Celia Buñag, Supervising Administrative Officer of Quezon City General Hospital.

(Removing the SPC is really a big effect because many of our patients have recurring illnesses such as pneumonia and Chronic Obstructive Pulmonary Disease. We really cannot reject the patient because they would need to be treated because there are really many patients who have recurring sickness.)

On the other hand, Lucila Salvador, a PhilHealth member whose sister was readmitted due to Urinary Tract Infection was relieved when she learned about the news.

“Nagpapasalamat kami sa PhilHealth, napakalaking bagay nito. Ang ate ko ay senior citizen at three times na siyang na-ospital sa paulit-ulit na sakit. Kinakabahan ako, kasi ang alam ko hindi na puwedeng gamitin ulit ang PhilHealth once nagamit na sa parehong sakit kasi one month ago pa lang noong na-confine siya bago ulit ma-confine rito,” she said.

(We thank Philhealth, this is a big thing. My elder sister is a senior citizen and she has been admitted to the hospital threee times, her illness recurs. I am worried because what I know is Philhealth cannot be used once it is used for the same illness. Because it was just only one month ago that she was confined and now she will be confined again here.)

Benefits

PhilHealth reminds members and qualified dependents that they are entitled to a total maximum of 45 days coverage for room and board per year.

However, this does not apply to the Hemodialysis benefits package as it has a separate 156 sessions allocated per year. PCEO Ledesma assures all members that PhilHealth continues to move forward with benefits enhancements to provide better financial coverage to all Filipinos.

“We are really working very hard 24/7. Talagang nagpapakahirap po kami because we understand that health is not just a privilege but an essential right for every Filipino. In these challenging times, we stand with them, and always make sure to deliver all the benefits they deserve,” Ledesma said.

(We are really working very hard 24/7. We are really working hard because we understand that health is not just a privilege but an essential right for every Filipino. In these challenging times, we stand with them, and always make sure to deliver all the benefits they deserve.)