PhilHealth sets new rates for virus cases starting April 15

MANILA, Philippines — Philippine Health Insurance Corp. (PhilHealth) on Tuesday released a new case rate package for patients afflicted with the new coronavirus disease (COVID-19) who will be hospitalized starting April 15.

PhilHealth president and CEO Ricardo Morales pointed out that while the state health insurer had “sufficient” funds, it needed to implement the rate package for COVID-19 patients to ensure its sustainability.

All Filipinos are covered by PhilHealth under the Universal Health Care Law, but a case rate package sets the maximum amount that the state insurer will pay for the treatment of a patient for a certain ailment. A patient would have to pay hospital charges over this amount out of pocket or through a personal health insurance.

“The PhilHealth fund is sufficient, but it’s not unlimited. That’s why we have to exercise due prudence,” Morales said in a briefing on Tuesday.

Morales said PhilHealth is currently paying for all the hospitalization and treatment costs incurred by patients who contracted SARS-CoV-2, the virus that causes the acute respiratory disease.

President Duterte on Monday night said PhilHealth benefits for COVID-19 cases would cover medical expenses ranging from P8,150 for testing to P786,834 for critical cases of pneumonia.

“The PhilHealth shall pay for all COVID-19 tests conducted outside hospitals or in nonhospital facilities, such as laboratories and drive-thrus, provided that the facilities are accredited by the Research Institute for Tropical Medicine,” the President said.

4 pneumonia categories

He added that the coverage of the benefit packages both for COVID-19-related pneumonia and community isolation will be reviewed over the next 30 days in order to adjust the rates.

Morales said PhilHealth had already paid an unnamed hospital P1.8 million. Another hospital has a running bill that now amounts to P3.2 million, he added.

Under the new package, coverage for COVID-19 patients is segregated into four categories, depending on the gravity of their conditions.

No official notice yet

Coverage for mild pneumonia is set at P43,997, moderate pneumonia at P143,267, severe pneumonia at P333,519, and critical pneumonia at P786,384.

Morales explained that the package was so designed since pneumonia was a serious complication brought about by COVID-19. It will be enforced on April 15, which means that PhilHealth will still cover all costs incurred by patients hospitalized prior to that date.

Some hospitals, however, said that while PhilHeath had publicly announced that it would cover the hospitalization of COVID-19 patients, they had yet to receive any official notice stating that from the state insurer.

For instance, VRP Medical Center director Dr. Veronica Regina Garcia said that as of Tuesday “we have not received any communication from PhilHealth that we’re not supposed to bill our patients right now.”

“We’re still waiting for that [notice],” Garcia said.

Morales acknowledged that not all hospitals may have been informed of the policy.

That’s why, he said, he had instructed regional vice presidents and personnel to relay the information to the hospital administrators under their jurisdictions.

PhilHealth has set aside P30 billion to pay hospitals that will claim reimbursements for patients covered by the state health insurance system and has already paid out P6 billion from that amount, Morales said.

Banks are currently unable to release as much PhilHealth funds because they are operating only with a skeleton staff, he said.

He assured hospitals that PhilHealth was already coordinating with the banks to expedite the fund releases.

Also on Tuesday, the Philippine Charity Sweepstakes Office said it would transfer about P420.6 million to PhilHealth to cover its COVID-19-related packages. —WITH A REPORT FROM JULIE M. AURELIO INQ