Outpatient TB Treatment Coverage for PhilHealth Members

The nation recently commemorated World Tuberculosis (TB) Day. According to data from the Department of Health (DOH) Central Visayas, there were 12,461 identified cases of TB in the region in 2011 and almost 97 percent of these were new cases.

PhilHealth reiterates that it covers outpatient anti-TB treatment or directly observed treatment short-course (DOTS) for new cases of pulmonary and extra-pulmonary TB. New case means that the patient has never had treatment for TB or has taken anti-TB drugs but for less than a month.

The benefit package is worth P4,000 which covers diagnostic work-up, consultation services and anti-TB drugs. The amount is paid to the accredited TB-DOTS facility handling the treatment on an outpatient set-up.

The benefit package will be paid to the DOTS facility in two separate payments. The first payment of P2,500 will be paid after the facility has completed the intensive phase of DOTS treatment for the patient, and the final payment of P1,500 will be paid after the end of the maintenance phase considered as the date of treatment.

The concerned DOTS facility will settle the payments to referral centers, physicians and other health workers. Additional services rendered or extensions of treatment are not covered under the benefit package.

PhilHealth also released Circular No. 18, series of 2011 in support of the United Nation’s Millennium Development Goals (MDG) to reduce the prevalence and mortality of TB by 50%. This circular provided the guidelines for the reimbursement of claims for TB in children nine years old and below.

Last year, PhilHealth Region 7 paid over 1.5 million pesos worth of coverage to accredited TB-DOTS facilities for a total of 785 new cases of TB.