Members readmitted due to the same illness in a span of 90 days can now avail of PhilHealth benefits after the state health insurer lifted its Single Period of Confinement policy beginning October 1. This applies to medical conditions and surgical procedures under the All Case Rate payment scheme.
The Single Period of Confinement Rule is a policy developed during the Philippine Medicare era which imposes that admissions and readmissions due to the same illness or procedure within a 90-calendar day period shall only be compensated once. This has resulted in members paying for the entire hospitalization and caused denial of claims on the side of health facilities.
“After extensive evaluation, we have lifted the rule of Single Period of Confinement to ensure continuous coverage for patients with recurring conditions,” said PhilHealth Chief Emmanuel R. Ledesma, Jr. during a recent media forum.
“This move also shows our strong commitment to fulfill our mandate — to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all Filipinos”, he added.
The lifting of the policy was well-received by healthcare providers and members. “Napakalaking epekto ang pag-alis ng SPC dahil karamihan sa pasyente namin ay recurring ang sakit gaya ng pneumonia at Chronic Obstructive Pulmonary Disease. Hindi naman natin puwedeng tanggihan ang pasyente dahil kailangan silang ma-treat dahil marami talagang pasyente ang may recurring sickness”, said Ma. Celia Buñag, supervising administrative officer of Quezon City General Hospital.
PhilHealth reminds members and qualified dependents that they are entitled to a total maximum of 45 days coverage for room and board per year. However, this does not apply to the Hemodialysis benefits package as it has a separate 156 sessions allocated per year. PCEO Ledesma assures all members that PhilHealth continues to move forward with benefits enhancements to provide better financial coverage to all Filipinos.