Are you or a loved one in need of heart surgery? You must be wondering, “Is heart surgery covered by PhilHealth?” The good news is that yes, it is covered! With a country-wide government-funded health insurance program like PhilHealth, patients seeking medical and surgical intervention for various heart conditions can receive financial assistance. This service is a great step towards making affordable and quality health care accessible to a larger group of Filipinos.
Heart surgery is not something to be taken lightly, whether it’s a simple or complex procedure. However, the fact that PhilHealth covers this sometimes life-saving procedure can provide a sense of relief to patients and their families. Planning for medical procedures, especially surgery, can be a daunting task both emotionally and financially. With PhilHealth coverage, Filipinos will have a better chance of getting the help they need without significant financial burden.
Despite the coverage of heart surgery, it’s important to note that there are still certain medical procedures and surgeries that may not be covered by PhilHealth. It’s essential to thoroughly review your eligibility and policy inclusions to avoid surprises or unexpected costs. Nevertheless, PhilHealth’s coverage of heart surgeries is a step in the right direction in providing Filipinos with access to affordable and quality healthcare.
Philhealth Coverage for Heart Surgery
One of the biggest concerns for patients undergoing heart surgery is the cost of the procedure. Fortunately, for those who are members of Philhealth, there is the possibility of availing of Philhealth coverage for heart surgery.
However, it is important to note that not all heart surgeries are covered under Philhealth. The coverage depends on the specific procedure performed as well as the patient’s membership status and the number of contributions made. The following are some of the heart surgeries that are covered by Philhealth:
- Coronary Artery Bypass Graft Surgery (CABG)
- Intracardiac Defibrillator Implantation (ICD)
- Pulmonary Thromboendarterectomy (PTE)
- Valvuloplasty and Valve Replacement Surgery
The Philhealth coverage for heart surgery varies depending on the procedure performed. For CABG, the coverage is up to 550,000 pesos, while for valve replacement surgery, the coverage is up to 320,000 pesos. It is important to note that these coverage limits may change without prior notice.
In addition to the coverage limit, Philhealth also has certain requirements for eligibility. Patients should have made at least three months’ worth of contributions within the six months prior to the date of confinement. They should also have no existing Philhealth case rate for the same diagnosis and are not eligible for other healthcare benefits from government programs.
| Procedure | Coverage Limit |
|---|---|
| Coronary Artery Bypass Graft Surgery (CABG) | 550,000 pesos |
| Intracardiac Defibrillator Implantation (ICD) | 500,000 pesos |
| Pulmonary Thromboendarterectomy (PTE) | 550,000 pesos |
| Valvuloplasty and Valve Replacement Surgery | 320,000 pesos |
It is important to consult with your healthcare providers and Philhealth representatives to determine the specific requirements and coverage for your heart surgery. It is also advisable to prepare and submit all the necessary documents to ensure a hassle-free insurance claim process.
Qualifications for Philhealth Coverage on Heart Surgery
PhilHealth, as a national health insurance program in the Philippines, provides financial assistance to eligible members who undergo various medical procedures and treatments. For heart surgery, there are certain qualifications that must be met to avail of PhilHealth coverage.
- The member must be an active PhilHealth contributor for at least three (3) months prior to the hospital admission or surgery.
- The member must have sufficient premium contributions and has not exceeded the allowable benefit limit, which varies depending on the type of cardiac surgery.
- The heart surgery must be performed by a PhilHealth-accredited hospital and surgeon.
It is important to note that PUI and COVID-19 testing are required for patients before undergoing any cardiac surgery, and PhilHealth provides coverage for these tests. Additionally, PhilHealth covers heart surgeries for both adults and children, but some specific procedures may have age limitations.
Below is a table showing the allowable benefits for specific cardiac procedures covered by PhilHealth as of January 2021:
| Procedure | Case Type | Allowable Benefit |
|---|---|---|
| Valvuloplasty | Normal confinements; no complications | PHP 320,000 |
| Valvuloplasty | Normal confinements with specified complications (e.g. heart failure, pneumonia) | PHP 550,000 |
| Coronary Artery Bypass Graft | Normal confinements; no complications | PHP 550,000 |
| Coronary Artery Bypass Graft | Normal confinements with specified complications (e.g. infection, stroke) | PHP 800,000 |
| Heart Transplant | Normal confinements; no complications | PHP 1,400,000 |
| Heart Transplant | Normal confinements with specified complications (e.g. sepsis, renal failure) | PHP 1,600,000 |
It is advisable to inquire personally with PhilHealth and the chosen hospital regarding the specific requirements and documents needed to avail of the benefits. PhilHealth’s official website also provides updated information on covered benefits and requirements.
Procedures Covered by Philhealth for Heart Surgery
Heart surgery can be a life-saving procedure for patients suffering from various heart conditions. However, it can also be an expensive treatment option. Thankfully, the Philippine Health Insurance Corporation (Philhealth) provides coverage for heart surgery for its members and their qualified dependents. Here are the procedures covered by Philhealth for heart surgery:
Procedures Covered by Philhealth for Heart Surgery
- Coronary Artery Bypass Graft (CABG) – This procedure is for patients with blocked arteries in their heart. It involves taking a healthy vein or artery from another part of the body and using it to bypass the blocked artery, allowing blood to flow freely to the heart.
- Valve Replacement or Repair – This surgery is for patients with heart valve disorders such as stenosis or regurgitation. It involves replacing or repairing the damaged valve to improve blood flow and prevent complications such as heart failure.
- Open Heart Surgery – This procedure is for patients with various heart conditions that cannot be treated with less invasive methods. It involves opening the chest to access the heart and perform the necessary repairs or replacements.
Procedures Covered by Philhealth for Heart Surgery
Aside from the specific procedures mentioned above, Philhealth also covers other necessary expenses related to heart surgery, such as laboratory tests, medications, and hospitalization fees. However, certain conditions and requirements must be met to qualify for Philhealth coverage, such as being an active member and having the required number of contributions. It is best to consult with a Philhealth representative or healthcare provider to know more about the specific requirements and coverage eligibility.
Here are some of the general requirements for Philhealth coverage for heart surgery:
- The patient must be admitted to a Philhealth accredited hospital.
- The procedure must be done by a Philhealth accredited surgeon.
- The patient must have the required number of contributions and must not have any outstanding balance.
Procedures Covered by Philhealth for Heart Surgery
Here is a table of the Philhealth coverage for specific heart surgery procedures:
| Procedure | Case Rate | Professional Fee |
|---|---|---|
| Coronary Artery Bypass Graft (CABG) | Php 550,000 | Php 44,000 – Php 88,000 |
| Valve Replacement or Repair | Php 320,000 – Php 750,000 | Php 44,000 – Php 88,000 |
| Open Heart Surgery | Php 550,000 – Php 750,000 | Php 44,000 – Php 88,000 |
It is important to note that the actual cost of heart surgeries may vary depending on several factors such as the severity of the condition, hospital fees, and professional fees. Patients are advised to confirm the Philhealth coverage and other possible costs with their healthcare provider.
Benefits of Philhealth Coverage on Heart Surgery
Heart surgery is one of the most expensive medical procedures in the world. Fortunately, Philhealth offers coverage for heart surgeries, which greatly relieves the financial burden of patients and their families. Here are some of the benefits of Philhealth coverage on heart surgery:
- Reduced out-of-pocket expenses – Philhealth coverage can greatly reduce the out-of-pocket expenses of patients and their families. This can make heart surgery more accessible and affordable for those who need it.
- Access to top-quality medical care – With Philhealth coverage, patients have access to some of the best hospitals and medical professionals. This ensures that they receive top-quality medical care, which is essential for a successful heart surgery.
- Peace of mind – Knowing that Philhealth coverage is available can give patients and their families peace of mind. They will worry less about the financial aspect of the procedure and focus more on the recovery process.
Philhealth Coverage on Heart Surgery
Philhealth provides coverage for various types of heart surgeries, including:
- Coronary artery bypass graft (CABG) – This is a surgical procedure that reroutes blood around clogged or narrowed arteries in the heart.
- Heart valve replacement – This involves replacing a damaged or diseased heart valve with an artificial valve.
- Heart transplant – This involves replacing a patient’s heart with a healthy heart from a donor.
Philhealth Coverage Requirements for Heart Surgery
To be eligible for Philhealth coverage on heart surgery, patients must fulfill certain requirements, such as:
- Being a Philhealth member – Only Philhealth members are eligible for coverage on heart surgery.
- Meeting the contribution requirements – Members must have made the required number of contributions to be eligible for coverage. The exact number of contributions may vary depending on the specific heart surgery.
- Adherence to pre-approval requirements – Philhealth requires pre-approval before a heart surgery can be performed. Patients must adhere to the pre-approval requirements and procedures to be eligible for coverage.
Philhealth Coverage Rates for Heart Surgery
The exact Philhealth coverage rates for heart surgery may vary depending on the hospital and the specific type of heart surgery. However, Philhealth typically covers a significant portion of the total cost of heart surgery. The table below shows the Philhealth coverage rates for some of the most common heart surgeries:
| Heart Surgery | Philhealth Coverage Rate |
|---|---|
| Coronary Artery Bypass Graft (CABG) | Up to Php 550,000 |
| Heart Valve Replacement | Up to Php 320,000 |
| Heart Transplant | Up to Php 1,400,000 |
It’s important to note that the actual amount of Philhealth coverage may vary depending on several factors, such as the hospital’s accreditation level and the patient’s length of stay.
In summary, Philhealth coverage on heart surgery offers several benefits, including reduced out-of-pocket expenses, access to top-quality medical care, and peace of mind. Patients must meet certain requirements, such as being a Philhealth member and adhering to pre-approval procedures, to be eligible for coverage. Philhealth typically covers a significant portion of the total cost of heart surgery, which greatly relieves the financial burden of patients and their families.
How to Avail Philhealth Coverage for Heart Surgery
Heart surgery is considered a major operation that requires a lot of planning and preparation. One of the concerns of patients who are about to undergo this procedure is the cost. Fortunately, Philhealth, the Philippine government’s health insurance program, provides coverage for heart surgery, as long as certain conditions are met.
- Make sure that you are a Philhealth member and that your membership is active. If you are not yet a member, you can apply for membership at any Philhealth office or through their website.
- Be aware of the Philhealth coverage for heart surgery. The coverage amount varies depending on the type of procedure and the hospital where the surgery will be conducted. Consult with your surgeon or hospital to determine the exact cost of the surgery and the corresponding Philhealth benefits.
- Ensure that the hospital where the surgery will be conducted is accredited by Philhealth. This is important because non-accredited hospitals may not be able to provide Philhealth benefits to their patients.
- Submit the required Philhealth documents to the hospital or surgeon prior to the surgery. These documents include the Philhealth claim form, the patient’s Philhealth ID or MDR, and the hospital bill. Make sure to submit these documents on time to avoid delays in the processing of your Philhealth benefits.
- Follow the pre-approval process for the surgery if required by your surgeon or hospital. This involves obtaining approval from Philhealth before the surgery is conducted. Your surgeon or hospital will guide you through this process.
If you have any questions or concerns about your Philhealth coverage for heart surgery, don’t hesitate to consult with your surgeon, hospital, or any Philhealth representative. Being well-informed and prepared can help ensure a smooth and hassle-free process for your heart surgery and Philhealth benefits.
Additional Notes
It’s worth noting that Philhealth coverage for heart surgery is subject to change, and the benefits may vary depending on different factors. To make sure you are getting the most accurate information, it’s best to consult directly with Philhealth. Additionally, there may be other financial assistance programs available to help cover the cost of your heart surgery, such as government subsidies or charitable organizations. Don’t hesitate to explore all your options to make sure you are getting the best possible care for your heart condition.
List of Required Philhealth Documents for Heart Surgery Coverage
| Document | Description |
|---|---|
| Philhealth claim form | Document that must be filled out and submitted to Philhealth to claim benefits for heart surgery. |
| Philhealth ID or MDR | The patient’s Philhealth identification or membership data record. |
| Hospital bill | The itemized bill from the hospital for the heart surgery. |
Make sure to have these documents ready and complete before your heart surgery to avoid any delays in the processing of your Philhealth benefits.
Additional Costs for Heart Surgery Not Covered by Philhealth
While Philhealth provides coverage for heart surgery, there are still some additional costs that patients should be aware of. Here are some of the most common:
- Professional fees: Philhealth only covers a certain percentage of professional fees, leaving the patient to pay the rest out of pocket. Depending on the surgeon and hospital, this can add up to a significant amount of money.
- Room and board: Although Philhealth covers a portion of room and board fees, some hospitals charge more than the amount that is covered. Patients should inquire with their hospital of choice to determine what additional fees may be incurred.
- Diagnostic Tests: While Philhealth covers certain diagnostic tests, it does not cover all of them. Patients may need to pay for additional tests, such as CT scans and MRIs, which can be quite expensive.
- Medications: Philhealth only covers a portion of medications prescribed during and after surgery. Patients may need to pay for additional medications depending on their condition and the medications prescribed by their physician.
- Rehabilitation and Therapy: Once patients have completed their heart surgery, they may require rehabilitation and therapy in order to fully recover. Philhealth does not cover these expenses, which can include physiotherapy and occupational therapy.
- Medical Supplies: Medical supplies such as catheters, implantable devices, and bandages are not all covered by Philhealth. These can add up to a significant amount of money, especially if the patient requires them for an extended amount of time.
Alternative Payment Options
While additional costs for heart surgery can be daunting, there are alternative payment options available. For example, some hospitals offer payment plans for patients who cannot pay the full amount upfront. Patients can also consider taking out a medical loan, applying for a credit card with a low interest rate, or seeking financial assistance through charity organizations.
Budgeting for Heart Surgery
It is important for patients to budget for heart surgery and its associated costs in order to avoid unexpected financial burdens. Patients should speak with their doctor and hospital to determine the estimated cost of the surgery and associated expenses. This information can help patients to plan financially and avoid any surprises.
Summary
| Cost Category | Estimated Cost (PHP) |
|---|---|
| Professional Fees | 10,000 – 50,000 |
| Room and Board | 1,000 – 10,000 per day |
| Diagnostic Tests | 5,000 – 25,000 |
| Medications | 5,000 – 20,000 |
| Rehabilitation and Therapy | 10,000 – 50,000 |
| Medical Supplies | 10,000 – 30,000 |
While Philhealth can help to offset the cost of heart surgery, patients should be aware of the potential additional costs. By budgeting and exploring alternative payment options, patients can alleviate financial stress and prioritize their health.
Philhealth-accredited Hospitals for Heart Surgery
Heart surgery can be a costly procedure, and it’s important to know if your Philhealth insurance covers it. Fortunately, many hospitals are accredited by Philhealth to provide heart surgery services to their members. Here are the top Philhealth-accredited hospitals for heart surgery:
- The Philippine Heart Center – With over 200 beds dedicated to cardiovascular care, the Philippine Heart Center is the premiere hospital for heart surgery in the country. It offers services such as Coronary Artery Bypass Grafting (CABG), Open Heart Surgery, and Valve Replacement Surgery.
- St. Luke’s Medical Center – With locations in Quezon City and Global City, St. Luke’s Medical Center is one of the most well-known hospitals in the country. It is also one of the top Philhealth-accredited hospitals for heart surgery services.
- Asian Hospital and Medical Center – Located in Alabang, Asian Hospital and Medical Center offers a wide range of cardiology services, including heart surgery. Its Heart Institute provides various procedures from cardiac catheterization to heart transplant surgeries.
Cost Coverage
When it comes to heart surgery, Philhealth has varying rates for different services. Here is a table that shows the Philhealth coverage for cardiac procedures:
| Heart Procedure | Philhealth Coverage |
|---|---|
| Coronary Artery Bypass Grafting (CABG) | 550,000 PHP |
| Valve Replacement Surgery | 320,000 PHP |
| Open Heart Surgery | 550,000 PHP |
It’s important to note that the coverage amount may vary depending on the severity of your condition and the hospital you choose. Always check with your healthcare provider and Philhealth to know the exact cost that will be covered.
Is Heart Surgery Covered by Philhealth: FAQs
Q: Is heart surgery covered by Philhealth?
A: Yes, heart surgery is covered by Philhealth as long as the patient meets the requirements set by the government agency.
Q: What are the requirements needed to avail of Philhealth’s heart surgery coverage?
A: The patient must be a Philhealth member and has enough contributions. Also, the patient must have undergone certain diagnostic procedures and have a valid recommendation from a specialist.
Q: How much of the heart surgery cost will Philhealth cover?
A: The amount of coverage varies depending on the type of heart surgery performed. Philhealth covers up to ₱550,000 for open-heart surgery and ₱100,000 for heart valve surgeries.
Q: Does Philhealth cover expenses such as diagnostics and medications for heart surgery?
A: Yes, Philhealth covers necessary diagnostic procedures such as laboratory tests, X-rays, and electrocardiograms. Philhealth also covers medication expenses during and after the surgery.
Q: Can a non-Philhealth member avail of coverage for heart surgery?
A: No, only Philhealth members are eligible for heart surgery coverage.
Q: Can a patient still avail of Philhealth’s coverage if they have existing medical conditions?
A: Yes, as long as the patient meets all the requirements set by Philhealth, including pre-existing medical conditions.
Q: How can a patient avail of Philhealth’s coverage for heart surgery?
A: The patient or their representative must submit all the necessary documents to their local Philhealth office. The hospital or healthcare facility can also assist in processing Philhealth coverage.
Closing Thoughts
We hope we have answered your questions about Philhealth’s coverage for heart surgery. Remember, it is vital to understand the requirements and limitations set by Philhealth before availing of any of their services. Thank you for reading, and please visit us again soon for more information on healthcare in the Philippines.