Guide on PhilHealth Benefit for Outpatient Surgery of Members w/ Updated Accounts
PHILHEALTH BENEFIT FOR OUTPATIENT SURGERY – Here is a guide on the case rate amount, coverage, and guidelines to avail a PhilHealth benefit.
In the Philippines, the health insurance institution that is under the government is the Philippine Health Insurance Corporation. More commonly called PhilHealth, it is under the Department of Health (DOH).
Many Filipinos are PhilHealth members. They submit a certain amount monthly or quarterly to keep their accounts active and updated so they can avail the benefits and assistance in both emergency and non-emergency medical cases.
One of the outpatient benefits of PhilHealth is the PhilHealth benefit for outpatient surgery. This includes “elective (non-emergency) surgical procedures ranging from minor to major operations, where patients are safely sent home within the same day for pos-operative care”. The assistance is based on the All Case Rates set by the state-run health insurance agency.
Steps on How to Process PhilHealth Assistance:
- Step 1 – In processing your PhilHealth claim, there are documents that you need to prepare and it is a case-to-case basis depending on whether you are claiming an inpatient or outpatient benefit or which outpatient benefit you want to claim. There are also Z benefits for the members. While other documents may differ, you must prepare your PhilHealth ID.
- Step 2 – Once you have your document ready, present it to the billing office of the Health Care Institution (HCI) or hospital where you availed the medical services. Make sure that the HCI is accredit to PhilHealth.
- Step 3 – Wait for the processing of your claim. The case rate amount will be deducted from your total bill and the deduction may include both the case rate amount and the deduction on the professional fee of the doctor or the attending physician.
- Step 4 – Pay for the remaining hospital bill.
It is one of the wisest moves to make sure that your PhilHealth account is active and updated so in times of medical situations, whether it is an emergency or non-emergency, you have an entity to turn to for assistance. The benefits are not only for the sole account holder as well as the beneficiaries of the account holder – his or her spouse, childre, and parents depending on the order of beneficiaries set by the agency.
