A New Eyesight For Free From PhilHealth

In the recent past, I blogged about an unexpected benefit from PhilHealth when it lowered the number of contributions paid by an Individually Paying Member from nine (9) months to just three (3) months before he gets entitled to the health care benefits it gives to its members. This was followed by my revelation on how some medical practitioners manipulates the charging of their professional fees resulting to non-benefit by PhilHealth members on the Doctor’s Share of payment made by the state insurance company.

As if the “Net of PhilHealth” charging of the doctor’s professional fees is not enough disappointment, asking for the Official Receipts for the payment of their professional fees is another agonizing experience that I also blogged about. For a change, I will not write about my struggle to get what’s due us against the medical malpractices that I revealed in my previous blogs. I will do it later but for this time, I will narrate a positive experience that we recently had with PhilHealth and an ethical medical practitioner.

I have a 72-year old sister-in-law who is almost blind due to cataracts in both eyes. She is a Sponsored Member of PhilHealth by way of contributions paid by the local government of her hometown in Northern Samar. There is no facility for cataract surgery in her province so it has to be done in Metro-Manila and I have to assist her in finding an ophthalmologist (eye doctor) who would agree to perform the operation with expenses to be charged to PhilHealth.

Cataract surgery is listed among the surgical cases covered under PhilHealth’s Special Benefit Packages. Under the package, the ophthalmologist and the facility where the surgery will be done will be paid PhP16,000.00 per eye including the rigid-type (non-foldable) intra-ocular lens that will be implanted in the patient’s eye. This is the free new eyesight that PhilHealth gives to its members. Not bad if we consider that a patient without PhilHealth coverage will have to spend more than PhP25,000.00 for cataract surgery of just one eye.

We were lucky to be referred by someone who had undergone cataract surgery by an ophthalmologist though she cannot remember anymore if they paid extra for the procedure which was also covered by her PhilHealth insurance. After the screening tests done on my sister-in-law’s eyesight, her left eye was scheduled for operation as soon as PhilHealth gives its pre-approval of the application for benefit.

We got the pre-approval three (3) weeks after the application was filed. We were told by the doctor’s secretary that it normally takes one (1) week only but because everything was coursed through them, I have no way of knowing what caused the delay. The procedure was done last Tuesday, November 26, 2013 and healing continues as of this writing. So far, we have only spent for PhP750.00 for the medicines and her right eye is scheduled for surgery as soon as PhilHealth pre-approves the second application for the Case-Rate Benefit that we filed a day after the surgery of her left eye. I hope it won’t take another three (3) weeks for us to get the pre-approval this time.

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