PB hails PhilHealth for its hemodialysis program

CEBU, Philippines —  The Cebu Provincial Board has commended the Philippine Health Insurance Corporation (PhilHealth) for “allowing its members who are registered in its Chronic Kidney Disease Stage 5 (CKD 5) database to avail of a maximum of 144 hemodialysis sessions from the previous 90 sessions until the end of the year 2022.”

Copy of the PB resolution furnished to PhilHealth Regional Office VII states that “hemodialysis treatment per session costs quite a bundle of money which is why many, especially among the marginalized, are at wits’ end and are trying to scrounge sources of funds to be able to meet the prescribed treatment schedules with the number of sessions required.”

“[Thus, it is] a great advantage for PhilHealth CKD 5 registered members that such a measure is available for them as it will ease their economic burden as well as the mental stress that goes with it,” part of the resolution reads.

As a basic rule in availing PhilHealth benefits, each member is entitled to a maximum of 45-day coverage and a separate 45 days to be shared by all the dependents per calendar year.

In August of this year, PhilHealth released Circular No. 2022-0017 increasing the coverage of CKD patients 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.

Earlier, the coverage of CKD stage 5 patients was also extended to 144 sessions at the height of the COVID-19 pandemic through Circular Nos. 2021-0002 and 2021-0009.

PhilHealth Regional Office VII records show that in 2021, hemodialysis has the most number of filed claims among its covered procedures with benefit payments amounting to P358 million.

As of August this year, the regional office has paid nearly P146 million for claims on hemodialysis.

From 2021 to August 2022, there are about a little over 2,000 CKD patients in Central Visayas who are registered in the PhilHealth Dialysis Database.

It can be recalled that in 2015, PhilHealth, through Circular No. 22 and 24, expanded the coverage for hemodialysis from 45 to 90 sessions per year in order to help lessen the financial burden of members undergoing such procedure.

PhilHealth said that additional outpatient dialysis sessions after the exhaustion of the regular 45-day benefit limit were derived from the unused benefit allotted for the principal member, if the patient is a dependent; or the allotted 45 days to be shared by all the dependents, if the patient is the principal member, within the calendar year.

Coverage for hemodialysis may be availed at PhilHealth-accredited Health Care Institutions (HCI) nationwide, such as hospitals and dialysis clinics.

Currently, there are 55 accredited HCIs in Central Visayas providing hemodialysis procedures, 22 of which are dialysis clinics situated in Cebu.

Aside from hemodialysis, PhilHealth also has coverage for peritoneal dialysis or “PD First” worth P270,000 per year, and for kidney transplantation worth P600,000 under the Z Benefit package, which may be availed in contracted hospitals. — GMR (FREEMAN)