The Philippine Health Insurance Corporation (PhilHealth) has released a policy to serve as guidelines for paying the claims after the extension of hemodialysis coverage from 90 to 144 sessions in 2020.
According to Chief Social Insurance Officer Wilfred Hernandez, the policy which was released in April, will provide a definite guideline for reimbursement of claims for the 91st to 144th dialysis sessions.
“Confidently, makakapagbayad ‘yong PhilHealth offices sa buong Pilipinas kasi without this, wala silang basis para magbayad kasi yung announcement is not a policy. Iyong policy kasi natin ang basehan nila,” he said.
It can be recalled that PhilHealth approved the extension of hemodialysis sessions in November until December 31, 2020. However, the policy was not yet released after the announcement.
“Itong Circular No. 2 ng 2021, ‘yon lang ang policy na nagsasabi ng go to pay ‘yong mga dialysis session exceeding 90 days, 91 to 144 days. Iyon ang mga sessions na hindi nabayaran na siyang babayaran kaya lang for the year na coverage noon ay hanggang 2020 na may 144 days,” he said.
The policy circular stated that patients who did not have any deductions of the PhilHealth hemodialysis benefit from their actual charges and have paid their 91st to 144th hemodialysis at their own expense may directly file their claims with the PhilHealth regional/branch office or Local Health Insurance Office (LHIO).
Claims in which total hemodialysis benefits were already deducted from the patient’s actual charges shall be filed by health care providers, it added. Accredited health care providers shall ensure “full compliance in performance commitments and rules and regulations governing PhilHealth accreditation.”