PhilHealth Implementation of Case Rates Continues

PhilHealth President and CEO, Dr. Eduardo P. Banzon announced that the case rate method of paying for benefits for 23 medical cases and surgical procedures remains in effect in accordance with Circular 011, s-2011. All institutional health care providers are reminded to adhere to the provisions of the said Circular, as well as with Circular Nos. 011-A, 011-B, and 15, s-2011. At the same time, the ‘No Balance Billing’ (NBB) policy shall be applied to all Sponsored Program members and their qualified legal dependents when availing themselves of any of the 23 medical cases and surgical procedures in hospitals.

This means that no other fees or expenses shall be charged to or paid for by the member above and beyond the packaged rates. The NBB policy also applies when Sponsored Program members avail themselves of outpatient surgeries, hemodialysis and radiotherapy services in accredited non-hospital facilities that include Free-Standing Dialysis Centers (FSDCs) and Ambulatory Surgical Clinics (ASCs). It shall also be applied when they avail themselves of our existing outpatient packages for TB-DOTS, Malaria and HIV/AIDS.

The case rates and the NBB policy shall be subject to regular evaluation and adjustments to further the rationale of providing financial protection to our members, certainty in reimbursement information and efficiency in claims processing and business process flow.

Any inquiry may be directed to our Call Center at 441-7442 or at info@philhealth.gov.ph or at any of our offices nationwide. - https://www.affordablecebu.com/