PhilHealth now covers bilateral cataract surgery

THE Philippine Health Insurance Corp. now covers bilateral cataract surgery under two separate packages at P16,000 each.

The package covers facility or hospital charges at P9,600 and professional fee charges at P6,400.

Previously, cataract surgery for both eyes performed with less than a 90-day interval between each is treated as a single period of confinement and paid under one package rate only.

PhilHealth’s policy on single period of confinement bars coverage of re-admissions less than 90 days later for the same illness or injury. However, there are medical cases when complete quality care does not happen in one admission, but in a series of time-bound interventions that could happen within 90 days. Among these cases is bilateral cataract surgery.

With the recently issued PhilHealth Circular 17-2013, PhilHealth exempts bilateral cataract surgery from the 90-day period rule. Now, cataract procedures for both eyes done in the same or different confinement period with at least one-day interval between each will be paid as two separate packages, effective Aug. 21.

For instance, cataract surgery on the left eye done on Aug. 23 and cataract surgery on the right eye done on Aug. 25 will be covered as two separate packages because there is a one-day interval between the two procedures. This means the member will be able to avail of a total of P32,000 for the procedures on both eyes.