PhilHealth Benefit for Outpatient Hemodialysis – Case Rate Amount, Coverage & Guidelines to Avail

Guide on PhilHealth Benefit for Outpatient Hemodialysis of Members w/ Updated Accounts

PHILHEALTH BENEFIT FOR OUTPATIENT HEMODIALYSIS – Here is a guide on the case rate amount, coverage, and guidelines to avail a PhilHealth benefit.

Are you a member of the Philippine Health Insurance Corporation (PhilHealth) and you will be undergoing a hemodialysis? You can turn to the health insurance agency for assistance provided that you have an active and updated account.

Under the PhilHealth benefit for outpatient hemodialysis, the case rate is P2,600.00 per session. It covers both inpatient and outpatient hemodialysis procedures and there is a 90-day benefit limit with one (1) session equivalent to a one-day deduction.

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.