A Second Free Eyesight From PhilHealth

This article is about the second cataract surgery done on the right eye of my 72-year old sister-in-law last January 28,2014. The medical procedure was also for free, courtesy of Philippine Health Insurance Corporation (PhilHealth). But, unlike the first free cataract surgery that she had in November 26, 2013 when she got the Pre-Authorization Approval by PhilHealth after three (3) weeks upon filing her application for Case-Rate Benefit, this one took a lot more time than expected.

As stated in my earlier post about a new eyesight for free from PhilHealth, the application for her right-eye cataract surgery was filed a day after the operation done on her left-eye. She was advised by her doctor’s secretary that she could get the agency’s approval to be operated on by the second week of December 2013 which is alright because her sponsored membership with PhilHealth is only good until the end of the year. But, it did not happen that way. The year ended without her getting the confirmation call by the doctor’s secretary.

Come the first working day of 2014, she received a call confirming the approval of her application and was told that the surgery will be on January 7 provided that at least three (3) patients will be available for operation on that day. Unluckily, she was the only patient ready for surgery on the said date so the schedule was moved for another week. On January 14, there were two of them available for surgery and the ophthalmologist (eye surgeon) agree to perform the operation but upon checking my sister-in-law’s authorization online, its status changed from “Approved” to “Deferred” because her sponsored PhilHealth membership had lapsed so the surgery was postponed until her pre-authorization approval is cleared.

Upon my inquiry with the nearest PhilHealth Office, her membership needs to be renewed before she could avail of the deferred Case-Rate Benefit. For that to happen, her status has to be changed from Sponsored Member to Individually Paying Member because most of the local government units (LGUs) pay their dues to PhilHealth by mid-year. With no other recourse, I paid the Six Hundred (PhP600.00) Pesos insurance premium for one quarter and my sister-in-law finally got her second free eyesight last January 28, 2014.

With the experience that my sister-in-law had in getting her approved PhilHealth benefit deferred due to  failure of the sponsoring LGU to renew her membership in time, I now wonder how many indigent members are having the same problem. The situation could be avoided if the LGUs pay their premium dues on the first working day of the year. If done this way, their indigent constituencies would enjoy PhilHealth benefits all-year round. The question is how many LGUs are aware of the problem so they could make the necessary correction.

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