Coverage for planned CS includes preoperative test

CEBU, Philippines - Every pregnancy and birth is different from the other. Some women give birth through normal vaginal delivery while others have abdominal delivery or Cesarean Section (C-section).

Doctors will only require a C-section when the baby is in breech position or there is incidence of umbilical cord prolapse and cord coiling around the legs or neck of the fetus; or when the mother has hypertension or placenta previa; or the baby is larger than the pelvic capacity of the mother.

There is a large variation in the rates of C-section these days which basically depend on the kind of hospital and the doctor’s professional fee charges.

 But expectant moms who are PhilHealth members or are qualified dependents of members are assured of insurance coverage for their hospitalization cost, including preoperative procedures for those who opted for elective C-section.

Preoperative tests performed before a planned C-section are reimbursable by PhilHealth if these are part of the preoperative evaluation and management of the patient.

 These can include coverage for complete blood count, tests for hemostasis and other medically necessary procedures performed within 30 days prior to the onset of labor. These preoperative tests may vary depending on the medical profile of the patient.

C-section is generally classified as Case Type B under PhilHealth’s unified benefit schedule.

 A member or a qualified dependent who undergoes the procedure in a PhilHealth accredited Level 3 or 4 hospital (like the private-owned Cebu Doctors’ University Hospital or the government-owned Cebu City Medical Center) can avail herself of a maximum benefit of P500 per day for room and board charges, P14,000 for drugs, P10,500 for laboratory and others, and P3,000 for the operating room fee.

 Coverage for the professional fee of the attending physician is at P400 per day but not to exceed P2,400 for general practitioners, and P600 per day but not to exceed P3,600 for specialists.

 Coverage for the surgeon’s professional fee may either be P3,200, P7,200 or P8,400 depending on the qualifications of the surgeon performing the procedure. Coverage for the professional fee of the anesthesiologist is 40, 48 or 56 percent of the surgeon’s fee coverage depending on the qualifications of the anesthesiologist.

 Employed members are required to have at least three monthly premium contributions within the immediate six months prior to the month of delivery, while individually paying members must have at least nine months or equivalent to three quarterly premium contributions within the 12 months immediately before the month of delivery to avail of the benefits for C-section.

 Overseas Filipino workers and sponsored members may avail themselves of the benefits within the validity period of their coverage as reflected in their member data record or the family health card.   (FREEMAN NEWS)