Patients confined due to pneumonia, acute gastroenteritis, and urinary tract infection can now avail of PhilHealth benefits regardless of their length of stay in a medical facility.

The state-run Philippine Health Insurance Corporation (Philhealth) has removed its Length of Stay (LOS) requirement for the three conditions and will reimburse members who are hospitalized due to any of these medical conditions.

Philhealth Board Resolution No 2215, series of 2017, states it will cover in-patient claims for pneumonia, acute gastroenteritis, and UTI of eligible Philhealth members and their qualified dependents in all accredited institutions.

The LOS refers to the number of hours/day a member spent in an accredited healthcare institution from admission to discharge date.

Previously, the insurance firm required members to be admitted at least four days - or 96 hours - in pneumonia cases before they are approved for reimbursement. For acute gastroenteritis, it was three days, while UTI patients needed to be admitted for 96 hours. Any time less than that and members will not be reimbursed.

"Claims application without the required attachment of the certified true copy of patient clinical charts shall be returned to send (RTS)," according to the Philhealth circular.

Furthermore, "application of existing policies shall apply during pre-payment medical review. Any violation of the policies of the corporations shall cause the denial of the claim."

The Philhealth Circular will take effect 15 days after publication in news outlets with general circulation.

Meanwhile, the Philhealth Call Center, which the agency established to answer queries regarding membership and benefits, is now operating 24/7.

There are 20 call center agents ready to handle simple, structured questions which range from status of benefits, complaints, membership, registration, and number concerns. Nine other call center agents tasked to answer more complex issues that involve regional offices' concerns. MIMS

Read more:

What true universal health coverage entails
Philhealth to cover vulnerable kids