PhilHealth now allows ‘unli’ admission for same illness

Also plans to cover crutches, wheelchairs, canes

PhilHealth scrapped its single period of confinement policy to allow beneficiaries to be covered more than once for the same illness in a 90-day period.

PhilHealth Senior Vice President Israel Francis Pargas said the state health insurer is also studying the possibility of covering assistive devices.

“As a response to the request of our members, and of course of some lawmakers, we are now studying the possibility of covering assistive devices like wheelchairs, crutches, canes, walkers, and other devices like prescription glasses,” he said.

Pargas said the top 3 illnesses that cause patients to be readmitted are pneumonia, acute gastroenteritis and urinary tract infection.

DOH data showed the single confinement policy has led to the denial of 26,750 claims in 2023, covering community acquired pneumonia, acute gastroenteritis, urinary tract infection, and chronic kidney disease among other illnesses.

Of the number, some 1,700 claims of pneumonia patients who were readmitted in 2023 for the same illness within a 90-day period were denied by PhilHealth.

Coverage for pneumonia, for example, ranges from P32,000 for mild to moderate cases to P90,000 for severe cases.

“Starting October 1, all our members who will be confined or readmitted because of the same illness will now enjoy the same benefit,” Pargas said in a TeleRadyo Serbisyo interview.

Hemodialysis and chemotherapy patients are already exempted from the single confinement policy even before it was junked by PhilHealth.

“Part of the official issuance we will release is a transitory clause and whether the reimbursement will be direct to the patient or the hospital will be allowed to file for the patient,” Pargas said.