Drug dependency-related cases, covered by PhilHealth

Hospital confinements brought about by mental and physical conditions due to abuse of illegal substances are being paid for under the existing benefit schedule provided by the Philippine Health Insurance Corporation (PhilHealth).

In a recent Kapihan with national media, PhilHealth OIC-President and CEO Ramon F. Aristoza Jr. said that these conditions are among the components related to drug dependency that the state-run health insurer is paying for under the All Case Rate payment mechanism.

At the same time, Senior Vice President for Health Finance Policy Sector Ruben John A. Basa explained that hospitalization brought about by mental and behavioural disorders secondary to substance abuse are being paid for by PhilHealth at a package rate of P7,800, including payment for professional and hospital fees. In 2014 and 2015, PhilHealth has paid about P25 million in benefit payments for the said related cases.

PhilHeath is now working on a medical detoxification package to safely manage the acute physical symptoms of withdrawal associated with stopping the drug use.

Amid the present administration's drive against illegal drugs, the health insurer is presently working with the Department of Health and other stakeholders in the formulation of the guidelines for the said benefit package.

Meanwhile, PhilHealth has released a new policy covering orphans, abandoned and abused minors, out-of-school youths and children under its Sponsored Program. PhilHealth Circular No. 2016-0019 entitles them to benefit coverage such as access to inpatient, outpatient and primary care services, and to the application of the no balance billing policy.

Also discussed in the Kapihan is the institutionalization of PhilHealth services at the point-of-benefit availment provided by the PhilHealth Customer Relations and Empowerment Staff (PCARES). These are registered nurses deployed by PhilHealth to accredited hospitals nationwide.

According to Dr. Israel Francis A. Pargas, Spokesperson and OIC-Vice President for Corporate Affairs Group, the PCARES are the conduits of the Corporation to its members. "Their function is already institutionalized. Their function is not only to provide help in the membership issues and concerns of our members at the point-of-care but also to provide information, conduct surveys especially on some of our programs and policies," he said.

Kapihan with the PCEO is a semestral updating session of the PhilHealth President and CEO with media partners.

Source: Philippine Information Agency