How Much Will Philhealth Cover for Certain Medical and Surgical Cases?

How Much Will Philhealth

It is a good thing to be a member of Philhealth as it assures you of assistance in paying your hospital bills.  Their recent update on the guaranteed membership of Senior Citizens added to the insurance’s value to Filipinos.  Patients recovering from their illnesses can sleep soundly knowing that they can count on ready assistance from Philhealth.

To help us understand better how far Philhealth will go to support us in our hospital expenses, here is a “price list” of Philhealth’s participation on certain medical and surgical cases.  It is best to consult with your doctor or hospital as well to be sure of the fees that will be charged to your account.

Medical Cases (in Php)

  1. Dengue I (Dengue fever, DHF grades I & II) – 8,000
  2. Dengue II (DHF grades III & IV) – 16,000
  3. Pneumonia I (moderate risk) – 15,000
  4. Pneumonia II (high risk) – 32,000
  5. Essential Hypertension – 9,000
  6. Cerebral Infarction (CVA-I) – 28,000
  7. Cerebral Hemorrhage (CVA-II) – 38,000
  8. Acute Gastroenteritis (AGE) – 6,000
  9. Asthma – 9,000
  10. Typhoid Fever – 14,000
  11. Newborn Care Package in Hospitals and Lying in Clinics – 1,750

Surgical Cases (in Php)

  1. Radiotherapy – 3,000
  2. Hemodialysis – 4,000
  3. Maternity Care Package (MCP) – 8,000
  4. NSD Package in Level I Hospitals – 8,000
  5. NSD Package in Levels 2 to 4 Hospitals – 6,500
  6. Caesarean Section – 19,000
  7. Appendectomy – 24,000
  8. Cholecystectomy – 31,000
  9. Dilatation and Curettage – 11,000
  10. Thyroidectomy – 31,000
  11. Herniorrhaphy – 21,000
  12. Mastectomy – 22,000
  13. Hysterectomy – 30,000
  14. Cataract Surgery – 16,000

Source: http://www.pinoy-ofw.com/directory/question/how-much-is-the-amount-covered-by-philhealth-for-surgical-and-medical-cases

Ad

Published by MasterCitizen

I collect citizen facts and the usual stuff that might be important for a Pinoy's everyday life....Subscribe to get updates, opinions, and news.

87 thoughts on “How Much Will Philhealth Cover for Certain Medical and Surgical Cases?

    1. Hi Reah,

      Hindi po covered ng PhilHealth ang impacted wisdom tooth removal, pero, ang final decision po kasi will still depend sa kung ano ang i-issue na RVS code ng attending physician.

      Ibig pong sabihin, depende pa din po sa final diagnosis kung covered ngPhilhealth ang magiging final diagnosis ng doctor.

      MC

  1. Hi po sna masagot nyo po ang tanung ko. Naka aksidente po kc Asawa ko mabalian po young bata need po operahan may philhealth nmn po ang mgulang.. Magkanu po b covered ng Phil health ..tsaka sakop po b ng philhealthga gamot at bill s hospital? NSA private hospital po kc nka confine yung bata

    1. Hi Ben,

      Please confirm if this is the procedure to be done:

      GASTROTOMY; W/ ESOPHAGEAL DILATION AND INSERTION OF PERMANENT INTRALUMINAL TUBE (E.G., CELESTIN OR MOUSSEAUX-BARBIN).

      If yes, Philhealth covers that sickness up to P38,020.00.

      For more information, you may call Philhealth’s 24/7 hotline at 441 7442.

      MC

  2. Pano po sa akin covered po ng company bayad ko sa surgery ko pero nabigay ko po philhealth sa hospital o kaya na deduct po sa philhealth ko bayad tapos ask ko po company hindi ko ma re imburse sa company binayad ng philhealth..ano po maganda gawin salamat

    1. Wala ka na ngang binayaran sa surgery mo mag re reimburse ka pa sa Philhealth? Alam mo ba na hati kayo ng company mo sa pagabayad ng membership mo dyan? Direcho talaga ang pag de duct nyan sa billing mo.

  3. kalalabas lng nmin ng hospital ng mga anak ko.. ung bunso ko nagka pnuemonia 5days na admit .. 10.500 lng nkuha kong benefits sa philhealth kung 15k nmn pla sayang ung 4.500 .. konti nlng sana balance na binayaran q kung nasunod ung 15k .. hay naku mahal magkasakit

  4. Ooperahan po ako sa galbladder.ofw po asawa ko.ang sabi sa hosp.,nasa 130k ang magagatos.magkano po maibabawas ng philhealth namin.salamat po..

  5. nalapse po ung philhealth ko ofw ako dto sa dammam ksa,pghulog ko po ba umpisa.ulit ako za una..o continue lang po ung payment ko…

    1. Hi Madeliene,

      Pag nag start ka ulit mag hulog, itutuloy lang kung saan ka nag hinto. Hindi mawawala yung mga naihulog mo na noon.

      Huwag mo na ulit pababayaang mag lapse ang Philhealth mo para sigurado kang makaka avail ng benefits sa oras ng pangangailangan o pagkakasakit.

      MC

  6. hey good day.inquire lng po mgkano po ang bawas ng philheath sa lumbar disc surgery.wala kasi sa list.

    1. Hi Ramir,

      We tried searching too pero walang lumabas na Lumbar Disc Surgery. There were a lot of Lumbar Neuritis though and the case rates are as follow:

      Case Rate: 6,400
      Professional Fee: 1,920
      Health Care Institution Fee: 4,480

      We hope this helps. Pwede ka din tumawag sa Action Center hotline ng Philhealth for more details.

      MC

  7. Sir/Ma’am
    Sir may i ask if a patient underwent Triple Coronary Bypass how much he can avail from Philhealth. Is it true that the patient can avail only 21 thousand pesos for the said operation. Yet the hospital is charging millions from the patient. Do you have a package for this procedure?

  8. yung anak ko 15yrs lang may cataract na sa left eye nya gusto ko sanang paoperahan ma qualified kaya sya…member ako self emrloyed

  9. how about Calcaneal fracture surgery, covered din po ba ng philhealth? also sa ilalagay na Calcaneal Plates fee pwede dn po ba sa philhealth?

    1. Hi Xander,

      Based sa list of procedures and ailments ng PHilhealth online, hindi kasama ang Calcaneal fracture surgery. You can still ask your doctor or hospital, or call Philhealth’s action center just to be sure.

      MC

  10. Bakit PO imbes ibawas ng nga hospital ung professional fee share ng Philhealth ang ginagwa nila
    Dinadagdagan nila s Professional fee…KC ung pinapocess k ung bill ng anak ko without phic ang pf ng doctor NSA 500 LNG…Pero ung pknacompute ko ulit ang nangyari naging 1500 n of nya….Less phic 1000 still 500 p rin babayaran ko….Mnsan ang Alam ko 6000 ung pf ng pedia KC ngtanong me personal pagdting a bill nmin naging 7800 KC ung 1800 phic ….So parang wala LNG yung phic share s pf d member ang nakikinabang kng HND ang hospital

  11. gud day po.tanong ko lang po kung covered ng Philhealth ang removal ng tonsil?magkano po kaya ang philhealth benefit?baka pi kc maooperahan ang 7 years old na apo ko.thank you very much.

  12. Sir/madam
    Good evening mag tanong po ako kung papano ma idelivered yong birth certificate .Ako po ay wala sa pinas pero po may anak ako dalawa doon nag aral ngayon.Gusto ko mag kuha ng birth cert nitong 2 anak ko.Pero po yung city ko ay PAGADIAN CITY.Wala po itu sa list ng lugar na may delivery.paano po?

    Thank you po.

  13. Possible po bang maging dalawa philhealth mo. yung isa contribution yung isa indigenious?thanks sa sasagot. ano mas magandang gamitin?

    1. Hi Karen,

      Ang Philhealth number ay tulad din ng SSS at Pagibig, isang number lang ang ibibigay sa iyo at ito na ang magsisilbi mong identification habang buhay. Hindi it maaaring palitan, at hindi rin maaaring ma doble ang numbers para sa isang pangalan.

      MC

  14. Pwd po ba mgpa verypay sa philhealt Kong nka rinew ba ako.indaigent kc ako.ma’am
    And ask.LNG din ako Kong pwd ba kumoha nang I’d.Phil health ang indaigint.salamat po.

      1. Hi Jhelly,

        Ang mga ordinary dental services at cosmetic dental treatments ay hindi covered ng Philhealth:

        Tooth extraction
        Teeth cleaning
        Braces
        Teeth bleaching.

        MC

  15. Can you please clarify the benefits a philhealth member (senior citizen) could avail on haemodialysis? What does 4000 pesos cover? How long can a member avail as haemodialysis is a long-term treatment? Will there be a cap on the cover?

    Many thanks.

  16. Wala po ba me ma avail kung naka lapse me hulog ? Last 2006. Bale 2yrs lang nahulog ko !At kung pwedi ba na ma continues ko hulog ulit? Thanks !

  17. Mam/sir nagpatahi po ako ng noo at naaksidente ako ang binyaran ko po sa hospital ay 3,212 ang binawas po ng phic ay 2,100 me nkalagay po na excess na 5,019.98 marere fund po ba un.thank u po

  18. why is it that we need to be confined for atleast 24hours before we can claim philhealth benefits especially during check ups?

  19. I’m longtime paying philhealth. ofw for more than 20 years and every time going home before back work abroad I have to pay full 1 year in philhealth.and I never use it.at present still working Abroad.can I stop to pay philhealth or continue to pay.just asking.

  20. Gud pm . ask ko lng po sna if covered ng philhealth and impacted wisdom tooth extraction? Tnks po

  21. Panu po makakaupdate ng philhealth?qng meron tlga pong nairegistered aq..kz isa po aqng ofw..byad n rw aq isang taon cbi agency..gustu q lng mkasiguru qng me pangalan aq sa philhealth

  22. Sir / madam
    Magkanu po b makukuha if na operahan ang mother ko this march 8 sa singit po nilagyan sya ng bakal kc po na badfall po sya s motor.
    Pwede ko pa po b ma reinverse yung nagastos namin?
    thank u po..

      1. Gòod day, kung dpo ba accredited ang surgeon pwede po ba magclaim sa philhealth?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: