Cognizant of the needs of its members undergoing dialysis, the Philippine Health Insurance Corporation (PhilHealth) increases its coverage for outpatient hemodialysis from 90 to a maximum of 144 sessions for calendar year 2022.
In its Circular 2022-0017 published on August 3, 2022 which took effect immediately, PhilHealth members and their dependents with chronic kidney disease stage 5 (CKD) who are registered in the PhilHealth Dialysis Database are allowed to avail of the maximum 144 hemodialysis sessions until December 31, 2022, provided that the dialysis sessions are prescribed by their attending physicians.
The state insurer also emphasized that the 91st to 144th sessions shall be exclusively used for outpatient dialysis only and any unused sessions will not be carried over to calendar year 2023.
Moreover, qualified CKD patients who already used their 91st to 144th dialysis sessions and were not able to avail of the automatic deductions of the benefits from their medical bills can still directly file their claims with any PhilHealth Regional/Branch Office or Local Health Insurance Offices per existing guidelines.
Also reiterated in the guidelines is the application of the No Balance Billing (NBB) Policy wherein no other fees or expenses shall be charged or be paid for by qualified patients above and beyond the packaged rates as per PhilHealth Circular No. 2017-0017.
Those eligible of the NBB policy are indigent, sponsored, registered kasambahay, senior citizens, and lifetime members when availing benefits in government health care institutions.
Furthermore, in case of delay of filing of claims due to natural calamities or other fortuitous events, PhilHealth shall likewise extend the filing period of claims from 60 to 120 days provided that the area where the patient is located or being treated is under a state of calamity.
At a case rate of P 2,600 per session for a total of 90 sessions, hemodialysis patients are availing a maximum of P234,000 per year as health insurance coverage from PhilHealth.
With the increase of coverage this year to 144 sessions, patients can avail of a maximum of P374,400.
