07 - 10

The fourth and final installment of our series on Philhealth benefits will focus on orthopedic surgeries, renal diseases, and other types of cancer.  When availing of these benefits, it is best to see a Philhealth representative at the hospital where you are confined or call their Action Center number at 02-447-7442.

Read on.

Benefit Package and Amount Selections Criteria
Z MORPH (Mobility, Orthosis, Rehabilitation, Prosthesis Help)

–          First right and / or left below the knee P15,000.00

–          Both limbs P30,000.00

a. Signed ME Form;

b. No associated disabilities or co-morbidities, such as contractures, deformities, mental, and behavioral incapacity, quadriparesis, cardiopulmonary disease;

c. Community ambulation with or without cane, crutches, or walker;

d. At least three months post-amputation, if acquired; and

e. At least 15 years and 364 days of age, if congenital.

Selected Orthopedic Implants

1. Implants for Hip Arthroplasty

a.  Implants hip prosthesis, cemented P103,400.

b. Total hip prosthesis, cementless P169,400.

c. Partial hip prosthesis, bipolar P73,180.

a. Signed ME Form;

b. Should pass Philhealth’s prescribed Clinical Features.

c. Pre-injury status: ambulatory patients.

d. With no more than two co-morbid illnesses based on physical status classification based on ASA.

2. Implants for Hip Fixation

a. Multiple screw fixation (MSF) – P61,500

a. Signed ME Form

b. Any hip fracture not covered under the total hip package for femoral neck fracture.

c. Pre-injury status: ambulatory patients.

d. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk).

3. Implants for Pertrochanteric Fracture

a. Compression Hip Screw Set (CHS) – P69,000

b. Proximal Femoral Locked Plate (PFLP) – P71,000

a. Signed ME form;

b. CHS: stable fracture of the intertrochanteric area.

c. PFLP: unstable/comminuted pertrochanteric fracture .

d. Pre-injury status: ambulatory patients.

e. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk).

4. Implants for Femoral Shaft Fracture

a. Intramedullary Nail with Interlocking Screws – P48,740.

b. Locked Compression Plate (LCP) – Broad/Metaphyseal/Distal Femoral LC – P50,740.

a. Signed ME Form

b. Should pass Philhealth’s requirements for Femora Shaft Fracture and physical status classification based on ASA.

“PD First” – for End-stage Renal Disease Requiring Peritoneal Dialysis – P270,000 per year. a. Signed ME Form (to be submitted annually together with the pre-authorization)

b. Patients must have a permanent Tenckhoff peritoneal dialysis catheter properly placed in the abdominal cavity;

c. Patients must have completed PD initiation in an accredited healthcare institution so that the patient is no longer uremic, with stable vital signs and adequately trained (patient himself/herself or a caregiver) to perform PD at home using manual exchanges;

d. Must pass Philhealth’s clinical criteria (including age of patient, history of cancer, etc.)

Colon and Rectum Cancer

a. Colon Cancer

– Stage I – II (low risk) – P150,000

– Stage II (high risk) – III – P300,000

b. Rectum Cancer

– Stage I (clinical and pathologic) – P150,000

– Pre-operative clinical stage I but with post-operative pathologic stage II – III

– Using linear accelerator as mode of radiotherapy P400,000.

– Using cobalt as mode of radiotherapy P320,000

– Clinical Stage II – III

-Using linear accelerator as mode of radiotherapy P400,000.

-Using cobalt as mode of radiotherapy P320,000.

It pays to be well-informed especially with government benefits such as financial assistance when a family member is sick and needs to be hospitalized.  Always make sure that you are transacting with a Philhealth-accredited health institution and medical practitioners.

If you have questions about Philhealth benefits, send us a message and we will do our best to find the answers for you.

Source: https://www.philhealth.gov.ph/benefits/

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Closet Queen

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