New PhilHealth rules on surgery coverage

CEBU, Philippines - There’s a bit of good news for cataract patients as the Philippine Health Insurance Corporation (PhilHealth) now covers bilateral cataract surgery under two separate packages at a case rate of P16,000 each.

With the recently issued PhilHealth Circular 17-2013, PhilHealth exempts bilateral cataract surgery from the 90-day period rule.

PhilHealth said that effective August 21, 2013, cataract procedures for both eyes done in the same or different confinement period with at least a one day interval between each will be paid as two separate packages.

Paid to the health care institution, this package is inclusive of coverage for facility or hospital charges at P9,600 and professional fee charges at P6,400.

Previously, cataract surgery for both eyes performed in less than a 90-day interval between each is treated as a single period of confinement and paid under one package rate only, and under their policy on single period of confinement bars coverage of readmissions less than 90 days later for the same illness or injury.

PhilHealth added that readmission for an illness or injury that has already been managed by a health care provider is highly discouraged and must be avoided.

Institutional health care providers and health care professionals must give complete optimum care to patients before discharging them.

Members may avail of this benefit package in PhilHealth-engaged hospitals and ambulatory surgical clinics providing cataract surgery.

The attending eye surgeon must also be PhilHealth-engaged and duly affiliated with the facility where the surgery will be performed.

Eye doctors who perform cataract surgeries are advised to update their affiliation profile with PhilHealth.  (FREEMAN)