“How much is my PhilHealth benefit for a specific illness?”
This is a common question a member poses when faced with prospects of hospitalization.
Gone are the days when PhilHealth cannot immediately provide the exact amounts of benefits for specific illnesses when faced with inquiries from its members. This development was made possible when the health insurer implemented its new benefit payment scheme, the All Case Rates, initially in 2011 and totally in 2014.
The shift in paying for the health insurance benefits to the health care provider from fee-for-service to Case Rates made it easier for PhilHealth to communicate the definite amount of benefits that every member should be able to avail himself of, and to empower them with the information as well.
Now, PhilHealth moves a step forward by introducing a user-friendly web facility known as the All Case Rates Search Engine, wherein members and even non-members can easily search for the rates that it pays for every compensable medical or surgical case.
“The facility is so easy to use, you only need to key in the name of the medical or surgical condition and the case rates will automatically be displayed,” said PhilHealth President and CEO Alexander A. Padilla.
The searchable field for the case rates is positioned at the right side of the enhanced PhilHealth Corporate Website Homepage. The web user may either search by case (description), by ICD 10 or by RVS codes to show the entire range of case rates. International Statistical Classification of Diseases and Related Health Problems Tenth Revision (ICD 10) and Relative Value Scale (RVS) are codes used by PhilHealth in identifying specific rates for every reimbursable medical condition and procedure.
The new facility also provides full description of the case, breakdown of fees/rates being paid for by PhilHealth to its accredited hospitals and physicians, categories of hospitals where a certain case may be availed of and even the compensable illnesses under the second case rates.
Aside from the new case rate search engine, the enhanced PhilHealth website offers various information modules and online services such as the e-registration and e-PRS to enable non-members to register online and employers to post their employees’ PhilHealth payments on real time, respectively.
“We are continuously making online innovations to make our services more receptive to the needs of our growing members here and abroad,” Padilla said. # Adapted News, PHILHEALTH