Cover all COVID hospitalization expenses, PhilHealth urged

MANILA, Philippines — All hospitals in the country, whether public or private, should make sure that bills of all coronavirus disease 2019 (COVID-19) patients are covered by the Philippine Health Insurance Corp. and should have “zero balance billings” when discharged, according to a lawmaker.  

Anakalusugan party-list Rep. Mike Defensor said those patients should not just be given a clean bill of health but also a clean bill of hospitalization.

“We want the No Balance Billing (NBB) policy to apply to every COVID-19 patient, regardless of PhilHealth’s packaging of the insurance coverage. PhilHealth should pay for the full hospitalization and treatment expenses of all COVID-19 patients… Every COVID-19 patient should not have to worry about paying a single centavo for hospitalization and treatment,” he insisted. 

Defensor, who sits as vice chairperson of the House committee on health, pointed out that under the NBB or “Walang Dagdag Bayad” policy, no direct medical expense shall be exacted from the patient for the duration of confinement.  

For admissions prior to April 15, PhilHealth fully paid for the hospitalization and treatment costs of all COVID-19 patients, some of whom incurred bills in excess of P1 million each. 

However, PhilHealth began adopting case rates for COVID-19 patients for admissions effective April 15. The bundles are:  P43,997 for those with mild pneumonia; P143,267 for those with moderate pneumonia; P333,519 for those with severe pneumonia; and P786,384 for those with critical pneumonia.

“The problem with case rate packaging is that not all COVID-19 cases in the same category are the same, precisely because we are dealing with a new disease. For instance, not all COVID-19 patients with critical pneumonia are the same. Some patients may have to stay longer in the intensive care unit (ICU) throughout their hospitalization, and they could end up getting billed in excess of the P786,384 case rate ceiling,” Defensor said. 

He added that PhilHealth should also guarantee the payment of all additional charges beyond the maximum amount for the package as he noted that the state-run health insurer has plenty of funds – including tens of billions of pesos in annual national government subsidy – to pay for the full cost of hospitalization and treatment of COVID-19 patients.

As of May 16, the Department of Health reported a total of 12,305 confirmed COVID-19 cases in the country with 2,561 recoveries and 817 deaths. 

But Puwersa ng Bayaning Atleta party-list Rep. Jericho Nograles has a different idea as he suggested that the pasaway (hardheaded) COVID-19 patients be excluded from PhilHealth’s coverage, especially those found to have contracted the disease due to irresponsible and reckless behavior.  

“From what I saw during the weekend, it seems to me that people have totally forgotten that the virus is still out there without any vaccine and without any real cure. I really fear for the second wave which could really jeopardize PhilHealth’s viability,” he said.