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PhilHealth recommends ending single confinement period rule — DOH

Philippines | National

PhilHealth recommends ending single confinement period rule — DOH

By Merlina Hernando-Malipot

The Department of Health (DOH) on Tuesday, Sept. 24, confirmed that the Benefits Committee (BenCom) of the Philippine Health Insurance Corporation (PhilHealth) recommended a new policy to remove the single period of confinement rule.

(PhilHealth / Manila Bulletin)

In a special meeting chaired by DOH Secretary Teodoro J. Herbosa, the BenCom decided to make the recommendation to the Board en banc, which is set to have its next regular meeting on Sept. 27.

“We are now in the era of the Universal Health Care Act of 2019, decades after the Philippine Medical Care Act of 1969,” Herbosa said.

“Technologies against fraud are also better today, so let us fix our policies to reduce the out-of-pocket payments of families,” he added.

The DOH noted that PhilHealth's All Case Rates (ACR) Policy No. 2 (PhilHealth Circular No. 0035, s. 2013) states: "The single period of confinement rule means that admissions and re-admissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one (1) case rate benefit. Therefore, availment of benefit for the same illness or procedure that is not separated from each other by more than 90 calendar days will not be provided with a new benefit until after the 90-calendar day period reckoned from the date of admission."

This single period of confinement rule, DOH explained, resulted in the denial of 26,750 claims in 2023 alone.

The DOH noted that the typical causes include community-acquired pneumonia, acute gastroenteritis, urinary tract infections, and chronic kidney disease, among others.

PhilHealth is an attached agency of the DOH.

Related Tags

PhilHealth DOH Secretary Dr. Teodoro "Ted" Herbosa DOH

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