PhilHealth implements no balance billing policy

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Tuesday, September 6, 2011


THE Philippine Health Insurance Corporation (PhilHealth) has started implementing its no balance billing policy (NBB) to provide optimal financial risk protection for all its members, especially the most vulnerable groups, including the poorest of the poor.

The policy shall apply to claims with admission for the most common medical and surgical conditions experienced as well as for maternity and newborn care packages.

“NBB shall mean that no other fees or expenses shall be charged or paid for by the patient-member above and beyond the packaged rates. For drugs and medicines, supplies or diagnostic procedures not available in the hospital, said facility shall purchase necessary items/services in advance on behalf of the member,” the Circular stressed, adding that the policy complements the new case rate packages that also took effect on September 1 in various PhilHealth-accredited health care facilities.

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The NBB policy shall apply to all PhilHealth-sponsored program members and/or their dependents for specified cases and under any of the following instances: When admitted in government facilities/hospitals; when claiming reimbursement for outpatient surgeries, hemodialysis and radiotherapy performed in accredited government hospitals and all nonhospital facilities like freestanding dialysis centers and ambulatory surgical clinics; and when availing of existing outpatient packages for TB-DOTS (P4,000), malaria (P600) and HIV-AIDS (P7,500 per quarter or P30,000 per year).

“In support of the country’s commitment to reduce maternal and infant mortality rates and improve maternal and newborn care as per the Millennium Development Goals, the policy, in addition to covering sponsored members and their dependents, shall also apply to any other member type in all accredited MCP (maternity care package) non-hospital providers,” PhilHealth added. “The policy shall cover claims for MCP and newborn care package in these facilities.” (CGC)

Published in the Sun.Star Bacolod newspaper on September 06, 2011.

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