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PIA Press Release
2010/03/23

Philhealth covers pyschiatric treatment

Iloilo City (23 March) -- Patients confined for psychiatric condition starting April 1, 2010 can now avail of Philhealth benefits.

However, Philhealth 6 Public Relations Officer Larry Tabsing clarified that the claims for mental and behavioral disorder shall be considered only for patients with acute attacks or episodes admitted for any of the following reasons: when aggressive or assaultive behavior presents danger to self or others; when the patient is suicidal; the patient becomes manic or depressed and there is gross impairment in judgment and reality testing; when medication side effects became disabling or potentially life threatening (e.g., severe parkinsonism, severe tardive dyskinesia, neuroleptic malignant syndrome); and, when undergoing special medical procedures such as electro convulsive therapy.

Hospitals are also required to submit PhilHealth Claim Form 3 and properly accomplished Mental Status Examination (MSE) Form if the main diagnosis or primary condition is classified as mental and behavioral disorder as part of the requirements when availing the benefit.

However, in cases wherein the main condition is non-psychiatric illness, management of mental and behavioral disorder may also be reimbursed provided that such condition is indicated in the admitting and/or final diagnosis "with appropriate codes". In such cases, Claim Form 3 and Mental Status Examination shall not be required.

"The rule on 45-day allowance per year applies to this benefit", said Tabsing as he reiterated that that claims for cases not requiring admissions remains non-reimbursable.

As a matter of policy, Philhealth compensates cases arising from confinement due to illness or injury and other day or ambulatory procedures such as general, eye, ENT, urological, gynecologic, orthopedic and other surgeries.

As it continues to ensure better benefits, it also caters to out-patient cases like dialysis care for end stage renal disease, chemotherapy and radiotherapy for cancer cases, maternity care up to 4th Normal Deliveries (NSD) as well as newborn care package (NCP). (Philhealth/PIA) [top]

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