DOH addresses PhilHealth coverage for leptospirosis, highlights comprehensive benefits

The Department of Health (DOH) addressed the PhilHealth coverage for leptospirosis during the #MediaSolusyon Kapihan session on Wednesday, Sept. 20.

Abigail R. Estrada, Chief Social Insurance Specialist from the Benefits Development and Research Department in the Health Finance Policy Sector of the Philippine Health Insurance Corporation, highlighted the significant expansion and enhancement of PhilHealth's benefits over the past 28 years.

Regarding leptospirosis, Estrada provided detailed insights into PhilHealth's coverage, which offered a reimbursement of P11,000 for patients diagnosed with the disease. Specific International Classification of Diseases (ICD) codes (A27.0, A27.8, and A27.9) were used to identify Leptospirosis cases eligible for PhilHealth reimbursement.

Estrada stressed the importance of hospitals including the correct ICD code on claim forms to facilitate proper reimbursement. The P11,000 coverage included both hospital and professional fees.

“For cases of leptospirosis complications necessitating dialysis, PhilHealth covered the cost through the "2nd case rate" system, amounting to P2,600 (comprising P2,250 for the hospital and P350 for the professional fee),” Estrada noted.

She also said that it was essential for patients to be confined for at least 24 hours to access these benefits. Members were entitled to a 45-day allowance per year, based on the number of sick days attributed to Leptospirosis. This benefit also extended to dependents, she explained.

Estrada also highlighted PhilHealth's ongoing initiatives, including the implementation of "PhilHealth Konsulta" and the development of a comprehensive outpatient benefits package (COBP) to align with the objectives of the UHC Act.

The PhilHealth Konsulta program, as per Estrada, covered patient consultations, specific diagnostic tests, and 21 identified medications. Members were required to register with consultation providers to access these benefits.

She also pointed out that the UHC Act sought to provide quality and affordable healthcare services to all Filipinos, covering population-based and individual-based health services.

These services were funded through collaborations between the DOH, local government units (LGUs), PhilHealth, health maintenance organizations (HMOs), and private health insurance (PHIs), Estrada said.

Estrada noted that whatever its relationship with leptospirosis may be, the benefits that PhilHealth provides for it can still be rationalized if the amount is insufficient. PhilHealth can further study this for Filipino citizens, she added.

PhilHealth's coverage now, as per Estrada, spans from primary to tertiary care, encompassing both outpatient and inpatient services.

This comprehensive coverage aimed to address the financial burden of various diseases, including catastrophic conditions, through "Z Benefit" packages, she added. 

Estrada emphasized the "Millennium Development Gold Benefit Package," designed to focus on maternal and child health and combat infectious diseases such as HIV, TB, and malaria.

The discussion also touched on the inclusion of Covid-19-related benefits as a response to the ongoing pandemic.

Estrada elaborated on the evolution of PhilHealth benefits, including the transformation of the "Outpatient Primary Care Package" into a comprehensive outpatient benefit package named "Konsulta Plus" to align with the Universal Health Care (UHC) Act.

She noted that PhilHealth's comprehensive array of benefits encompassed inpatient packages, outpatient benefits, and various medical procedures, including day surgeries, chemotherapy, radiotherapy, and hemodialysis sessions.

"From PhilHealth as the public health insurer and health insurance provider of national health insurance programs for all Filipinos, assured po kayo na sa tuwing makakasakit tayo na huwag naman sana, nandyan ang Philhealth para i-covered ang pagkakasakit ninyo (rest assured that whenever we get sick, hopefully not too often, PhilHealth is there to cover your medical expenses)," Estrada said. (Zekinah Elize Espina)