MANILA, Philippines – “PhilHealth, you are literally scamming your members!” - Cris Daday Cahilig
The furious netizen slammed PhilHealth for its supposed ‘24-hour rule’ after her nephew was refused pediatric ICU coverage because the newborn was rushed to the hospital on the same day that he was discharged.
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| The furious netizen posted about the situation on Facebook. Photo credit: Cris Daday Cahilig |
According to Cahilig, her nephew was born last February 22 and was discharged from the hospital on the 26th. However, for undisclosed reasons, the child was rushed to another hospital where his pediatrician is a resident.
Cahilig noted that PhilHealth had only covered around Php 5k+ of the Php 27k bill during the baby’s last confinement, whereas her brother-in-law had been paying the state’s medical insurance agency since 2004.
The angry netizen reminded PhilHealth that her brother-in-law had been paying them for 21 years yet the coverage for his son’s confinement is so measly.
Cahilig further added that her nephew’s bill has already reached Php70k as of posting on March 3, yet the second hospital refused coverage because of PhilHealth's alleged ‘24-hour rule’. Based on the unnamed hospital staff’s explanation to the family, the gap between the two confinements must be at least 24 hours for the second hospitalization to be covered.
[2nd Update] Read on https://www.facebook.com/share/p/13tmNGz6ZA/?mibextid=wwXIfr [1st Update] Read on...
Posted by Cris Daday Cahilig on Monday, March 3, 2025
But does PhilHealth actually have a 24-hour policy?
Based on our research, PhilHealth used to have a 24-hour policy but it applied to confinement coverage for a stay of at least 24 hours in the hospital. It means that PhilHealth used to only cover hospitalizations that lasted at least 24 hours, except for emergency cases. GMA News reported last October 2024 that the agency is set to amend this policy.
However, the case of Cahilig’s nephew doesn’t appear to be directly affected by this 24-hour policy. It’s actually under the single period of confinement rule. Under this old rule, PhilHealth only covers one confinement for the same illness in the span of 90 days. This rule has actually been lifted already under PhilHealth’s Circular No. 2004-0021.
Based on the lifting of the single period of confinement rule, PhilHealth must actually cover the second confinement of Cahilig’s nephew despite being admitted for the same case.
— Joy Adalia, The Summit Express
