Kinumpirma ng Department of Health (DOH) na ang Benefits Committee (BenComm) ng Philippine Health Insurance Corporation (PhilHealth) ay inirekomenda ang bagong polisiya na alisin ang single confinement period rule.
Ayon kay Health Secretary Teodoro J. Herbosa, nagpasya ang BenComm na irekomenda sa Board en banc, na nakatakdang magkaroon ng susunod na regular meeting sa Setyembre 27, 2024.
“We are now in the era of the Universal Health Care Act of 2019, decades after the Philippine Medical Care Act of 1969,” sabi ni Herbosa.
“Technologies against fraud are also better today, so let us fix our policies to reduce the out-of-pocket payments of families,” dagdag pa ng kalihim.
Batay sa PhilHealth All Case Rates (ACR) Policy No. 2 sa ilalim ng PhilHealth Circular No. 0035, s. 2013, nakasaad: “The single period of confinement rule means that admissions and re-admissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one (1) case rate benefit. Therefore, availment of benefit for the same illness or procedure that is not separated from each other by more than 90 calendar days will not be provided with a new benefit until after the 90-calendar day period reckoned from the date of admission.”
Paliwanag pa ng DOH, ang single period confinement rule ay nagresulta ng denial sa 26,750 claims nitong 2023. Ang mga tipikal na dahilan ay community-acquired pneumonia, acute gastroenteritis, urinary tract infection, at chronic kidney disease.
