PhilHealth assures coverage of patients admitted in ERs, tents

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Patients admitted in emergency rooms (ERs) and tents within the hospital compound pending availability of hospital rooms are covered by the Philippine Health Insurance Corporation (PhilHealth).

This was reiterated by the state health insurer as COVID-19 cases continue to surge and several health care facilities have reportedly been running at full capacity to accommodate patients.

In its Advisory Nos. 2021-027 and 2021-028, PhilHealth stressed the provision of PhilHealth Circular No. 35, s-2013 that when admitted patients must stay in ER or within the hospital premises pending availability of rooms, full payment shall be given, provided the patient stayed in the hospital for 24 hours or more.

The Department of Health through Memorandum No. 2020-0171 has instructed hospitals to adopt strategies to increase their capacities to manage COVID-19 during surge of cases that includes setting up tents when necessary.

PhilHealth beneficiaries admitted in tents within the compound of accredited hospitals in areas categorized as high to critical risk for COVID-19 shall be compensable starting March 29, 2021.

The state agency also asserted that patients including COVID-19 cases being admitted and managed in ER due to lack of available regular rooms shall be paid by PhilHealth if the patient stayed within the hospital for at least 24 hours. However, private hospitals are required to submit a justification letter together with their claim in compliance with the said policy.

On the other hand, patients confirmed with COVID-19 and developed into severe illnesses can avail themselves of inpatient benefits for mild pneumonia, P43,997; moderate pneumonia, P143,267; severe pneumonia, P333,519; and critical pneumonia for P786,384. An intermediate package for previously managed as probable COVID-19 case but had negative RT-PCR test results are also covered with the Intermediate package amounting to P18,000 and P38,000 for moderate and severe/critical pneumonia, respectively.

Meanwhile, PhilHealth calls on health care providers to honor all availments including those of patients staying in tents, ERs or within the hospital premises wherein services are provided as part of the inpatient care.

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