PhilHealth now covers selected orthopedic implants for members
Tags: Philhealth
The Philippine Health
Insurance Corporation (PhilHealth) now offers selected orthopedic implantable
devices for members, a press release from the agency said Wednesday.
Through the Z Benefit Packages, expenses for orthopedic implants for hip arthroplasty, hip fixation, pertrochanteric fracture, and femoral shaft fracture are now covered for members who pass screening.
According to PhilHealth President Alexander Padilla, they've recognized that the bulk of expenses for most orthopedic surgeries go to implantable devices.
“The high cost of these medical devices sometimes drives patients to stay longer in the hospital while some eventually refuse treatment due to financial concerns,” Padilla said.
Rates are as follows:
Through the Z Benefit Packages, expenses for orthopedic implants for hip arthroplasty, hip fixation, pertrochanteric fracture, and femoral shaft fracture are now covered for members who pass screening.
According to PhilHealth President Alexander Padilla, they've recognized that the bulk of expenses for most orthopedic surgeries go to implantable devices.
“The high cost of these medical devices sometimes drives patients to stay longer in the hospital while some eventually refuse treatment due to financial concerns,” Padilla said.
Rates are as follows:
·
Total hip prosthesis
(cemented) for members over 65 years of age – P103,400
·
Total hip prosthesis
(cementless) for members below 66 years of age – P169,400
·
Partial hip prosthesis
(bipolar), inclusive of rates for implants per side (left or right) – P73,180
·
Hip fixation, inclusive
of multiple screw fixations with washer – P61,600
Z package rates:
·
Inclusive of proximal
femoral locked plate – P71,000
·
Inclusive of compression
hip screw set – P69,000
·
Inclusive of locked
compression plate board, metaphyseal or distal femoral LC – P50,740
·
Inclusive of implants
for femoral shaft fracture – P48,740
·
PhilHealth also pays for
implants needed for pertrochanteric fracture.
Padilla noted that the Z benefit packages which are inclusive of surgery and implants are available initially at the Philippine Orthopedic Center.
“The medical devices shall be implanted to patients by PhilHealth-accredited physicians certified by the Philippine Board of Orthopedics and practicing in the contracted hospital,” he said.
No Balance Billing policy
Meanwhile, contracted hospitals shall transact only with medical device establishments, manufacturers or traders that are licensed by the Food and Drug Administration. Donated medical devices shall not be covered under the benefit package.
Padilla added that the No Balance Billing policy applies to indigent, sponsored, and kasambahay members. This means these members need not pay any amount in excess of what PhilHealth already covers for these orthopedic implants.
As for fixed co-pay, this will be applied for all other eligible members and their qualified dependents from other categories but in no instance will this exceed the rate of the specialized medical devices.
Members who avail of the Z benefit for specialized medical devices shall no longer be eligible for the same procedure on the same site for the next five years.
The PhilHealth's coverage for selected orthopedic implants took effect for all approved pre-authorization requests last June. — Andrei Medina/VC, GMA News
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