Today, I had a lot of learning experience and by that it means I paid for it like literally.
My son had a series of going in and out of the Emergency Room in just a month until finally we decided to admit him in Maria Reyna Hospital (MRXUH).
He had a bout with on/off fever like more than 12 hours of consistent fever unlike before the Paracetamol would help wear off the high temp within the 4 hours.
July 8 we had to have him checked due to irregular breathing at the ER since it was already pass the hour of the regular working hours. The first finding was he had tonsilitis which we were given oral antibiotics. The following week he was OK though the cough was still there. On the 21st, the fever began then rashes came in, and still the cough was still present within the week.
And because the fever was so persistent, I had him checked at the ER again on July 26 triggered by the rashes thinking it was dengue. We had him do CBC and the platelet count was within normal range (Thank God!).
Yet still, he had difficulty breathing so we had him checked with his pedia. And I was so concerned about his condition, I suggested to have him admitted which the Pedia agrees due to the loss of appetite which he had lose 1kg in weight from the previous month’s checkup. The Pedia was concerned of dehydration.
I was so confident like financially because of Philhealth and recently had acquired an HMO (the premium of the HMO is also proportional to its coverage) for my kids. By that I meant the annual premium was at 2,200 pesos with a coverage of 25,000 for the year. The last time he was admitted was in May 2019 and we only paid the doctor’s professional fee (without HMO at that time). The first case was Pneumonia and recently had the same findings this July.
Little did I know that Philhealth had this implementing guidelines on single confinement i.e. if you are admitted and re-admitted of the same illness within the 90day calendar period, we will only be compensated with 1 case rate not unless if the illness is under the exemption of SPC (Single Period Confinement). Like I was thinking was there a rule like this? Why did I not know this!
Circular No 0035 Series 2013
Single Period Confinement
In addendum, members of Philhealth are only entitled of 45 days benefit limit per calendar year. Crazy!
Good thing though that I had the HMO. If not, I must have had to ask my employer for an LOA. To note, next time I will also consider if the Doctor is accredited in that specific HMO. I was literally thinking that I had to pay nothing due to Philhealth and HMO.
It beats to know these guidelines of Philhealth and that to know the HMO’s exemptions also i.e. whether they apply single period confinement or regardless of illness until the coverage is fully consumed.
Read more in the link below.