PhilHealth includes uncomplicated leptospirosis in its case rates

By April Montes

Tuesday 21st of August 2012

DAGUPAN CITY, Aug 21 (PIA) -- The Philippine Health Insurance Corporation (PhilHealth) included uncomplicated leptospirosis in its case payment system to ease the burden of poor patients in the wake of recent floodings here.

Public Relations Officer Irene Martinez said, effective August 7, all admissions of uncomplicated leptospirosis shall be reimbursed as case rate of P11,000.00 for all member types.

“This means that services rendered to a patient are packaged and health care providers are paid a fixed amount. It will enable members to know outright how much benefits will PhilHealth provide for medical conditions and surgical procedures treated or performed at accredited facilities,” Martinez explained.

She added it will enable PhilHealth to reimburse accredited providers faster. The method shortens the turn-around-time of benefit claims processing as it is simpler and easier to administer compared to the fee-for-service (FFS) method.

Martinez as well said that PhilHealth still applies the No Balance Billing (NBB) policy in covering cases of uncomplicated leptospirosis especially for all sponsored program members as defined in the PhilHealth Circular No. 11, s-2011.

Subsequently, all non-members in areas affected by the recent flooding, diagnosed with uncomplicated leptospirosis, shall be automatically enrolled as PhilHealth Sponsored Program members and shall be accorded the benefits due to them.

“If a member contracted leptospirosis and he/she is really poorest of the poor, automatically he/she will be enrolled as sponsored program member,” reiterated Martinez.

Also, the period for filing of benefits claim of PhilHealth members and dependents is extended to 120 days for discharges covering the dates June 8 to August 21, 2012.

Martinez asserted, “In our mandate, the filing claim is 60 days upon discharge but since this is a special case, it was extended to 120.”

For accredited Institutional Health Care Providers (IHCPs) whose claim documents may have been damaged by the recent flooding, Martinez advised them to contact their office for the necessary assistance.

“They must submit an incident report here for re-processing of papers so that their claims will not be denied. They should serve a notice not later than 61 days in order that they will be given consideration,” said Martinez.

She stated that healthcare institutions claiming for treatments, procedures and other services that are considered emergency may be reimbursed by non-accredited facilities of PhilHealth provided they are licensed by the Department of Health (DOH).

Leptospirosis is among the world's most common diseases transmitted to people from animals. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, the eyes, or with the mucous membranes. (JCR/AMM-PIA 1 Pangasinan)