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PhilHealth Announces Rates for
Selected Orthopedic Implants July 23, 2014

SELECTED orthopedic implantable devices are now being paid for by the Philippine Health Insurance Corporation (PhilHealth).

Through the Z Benefit Packages, expenses for orthopedic implants for hip arthroplasty, hip fixation, pertrochanteric fracture, and femoral shaft fracture are now covered for members who pass the selections criteria.

"We recognize that for most orthopedic surgeries, the bulk of expenses go to implantable devices. The high cost of these medical devices sometimes drives patients to stay longer in the hospital while some eventually refuse treatment due to financial concerns," said Alexander A. Padilla, PhilHealth President and CEO.

He announced that the Z package rate for total hip prosthesis (cemented) for members who are 66 years old and above is P103,400.00 while the Z package rate for total hip prosthesis (cementless) for members who are 65 years and 364 days old and below is worth P169,400.00. "For partial hip prosthesis (bipolar), our Z package rate is P73,180.00, inclusive of rates for implants per side, whether left or right," Padilla said.

On the other hand, the Z package for hip fixation is at P61,500.00, inclusive of multiple screw fixation 6.5mm cannulated cancellous screws with washer.

PhilHealth also pays for implants needed for pertrochanteric fracture. The Z package rate inclusive of compression hip screw set is worth P69,000.00, while Z package rate inclusive of proximal femoral locked plate is P71,000.00.

Implants for femoral shaft fracture/tibial fracture such as intramedullary nail with interlocking screws are included in the Z benefit package worth P48,740.00, while locked compression plate broad / metaphyseal /distal femoral LC is covered by the Z benefit rate of P50,740.00.

Padilla emphasized that the Z benefit packages, which are inclusive of surgery and implants, are available initially at the Philippine Orthopedic Center. “The medical devices shall be implanted to patients by PhilHealth-accredited physicians certified by the Philippine Board of Orthopedics and practicing in the contracted hospital,” he said. On the other hand, contracted hospitals shall transact only with medical device establishments, manufacturers or traders that are licensed by the Food and Drug Administration. Donated medical devices shall not be covered under the benefit package.

The No Balance Billing (NBB) policy applies to indigent, sponsored, and kasambahay members, meaning, these members need not pay any amount in excess of what PhilHealth already covers for these orthopedic implants. "We want our members, especially the less privileged, to experience true financial risk protection that is why we are also implementing the NBB for these particular packages," Padilla said. On the other hand, the negotiated fixed co-pay shall be applied for all other eligible members and their qualified dependents from other categories, but in no instance shall the fixed co-pay exceed the rate of the specialized medical devices.

Members who avail of this Z benefit for specialized medical devices shall no longer be eligible for the same procedure on the same site for the next five (5) years. Coverage for selected orthopedic implants took effect for all approved pre-authorization requests beginning June 1 this year. (END)

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PhilHealth Announces Rates for Selected Orthopedic Implants