PhilHealth bares cataract payment

CEBU, Philippines - Members of Philippine Health Insurance Corporation who need cataract operations can now avail themselves of a case rate of P16,000 beginning May 1.

PhilHealth said the P16,000 case rate is part of the patient’s hospital charge of P8,000 and professional fee charge of P8,000.

According to PhilHealth, this applies whether or not the procedure will be done on one or both eyes in a single operation. This is also regardless if the setup as outpatient or inpatient, and the number of confinement days in the hospital.

The P16,000 will be the only payment of the patient who will be undergoing cataract surgeries on both eyes on one operation or two separate unilateral surgeries done in one confinement.

Also, two separate unilateral cataract surgeries done in two confinements which will not be separated of at least 48 hours will be treated similarly but it will be paid if it will reach the maximum given time.

Preoperative tests done before the patient is confined and the professional fee for the preoperative consultation will not be under the case payment scheme as well as the physician standby and anesthesia service and complex cataract surgeries.

Members who will be availing of services in ambulatory surgical clinics, which are accredited to perform cataract surgeries, will have the same benefit as those in accredited secondary and tertiary hospitals.

Employed members and those enrolled under the organized group payment scheme will be able to avail themselves of the benefit if they would have proof that within the six months prior to the availment, at least three months worth of premium had been remitted to Philhealth.

The individually paying members should also show proof that within the immediate 12 months prior to availment, at least nine monthly premiums have been paid.

Proof that benefit availment falls within the validity period of coverage should be shown by sponsored and OFW members while lifetime members need only their lifetime ID to avail of the benefit. — AJ de la Torre/LPM  (THE FREEMAN)