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The ‘single period of confinement rule’ provided that beneficiaries who are confined due to an illness can only be covered by PhilHealth once within a 90-day period. Not anymore.
MANILA, Philippines –The Philippine Health Insurance Corporation (PhilHealth) said its single confinement policy (SPC) has already been scrapped.
PhilHealth Executive Vice President Eli Santos told senators on Wednesday, October 2, that the policy shift took effect on October 1 even though the circular has yet to be published publicly.
“This will take effect October 1, 2024, Mr. Chairperson, and the policy will be published on October 7, 2024. This will have a retroactive effect effective October 1, 2024,” Santos told the Senate joint committees on Health and Demography and Finance.
The “single period of confinement (SPC) rule” provided that beneficiaries who are confined due to an illness can only be covered by PhilHealth once within a 90-day period. This leaves patients to fend for themselves in case they get readmitted for the same illness.
PhilHealth Corporate Affairs Vice President Rey Baleña said those who will pay for the cost of a readmission from October 1 to 6 are entitled to reimbursements. This applies to public and private health facilities.
“Readmissions starting October 1 this year will be covered by this lifting of the SPC rule,” Baleña told Rappler in a text message.
“At any rate, we will not deny claims affected. Paglabas ng circular (When the circular is released) and the system for this, all affected claims will be paid accordingly.”
He added that the state health insurer already called for an emergency meeting with the country’s hospital groups to inform them of the policy change ahead of time.
PhilHealth’s Benefits Committee (BenCom) had recommended on September 24 to scrap the policy. The recommendation was then adopted by the state insurer’s board of directors on September 27.
“We complied with our promise to lift the rule on single period of confinement,” Santos said.
Data from the DOH show that the controversial policy led to the denial of 26,750 claims in 2023. Most of the cases for readmission included community acquired pneumonia, acute gastroenteritis, urinary tract infection, and chronic kidney disease, among other illnesses.
To be again covered by PhilHealth, some patients were advised to change their diagnosis or reason for hospital admission. – Rappler.com
