The Philippine Health Insurance Corporation (PhilHealth) recently joined the Philippine Heart Center for Asia (PHCA) in the celebration of heart month with the Cardiac Z Benefit Summit held at the DAPA Hall at the PHCA premises in Quezon City.

The activity serves as a platform to showcase the hospital’s accomplishments in the implementation of PhilHealth’s Z benefit packages, particularly Coronary Artery Bypass Graft Surgery (CABG), Ventricular Septal Defect (VSD), and Tetralogy of Fallot (TOF). It also aims to showcase the testimonies of beneficiaries who have undergone successful operations under PhilHealth’s Z benefit package and are now living happy and healthy lives under the care of their respective loved ones.

“Divine intervention”

One of the beneficiaries of PhilHealth’s Z benefit package for CABG shared her journey of suffering from an “unhealthy” heart to living the fit life. “I prayed for divine intervention,” Rebecca Dumaguit, 62, a widow and an employee of the Commission on Audit (COA) narrated.

She remembers all too vividly, chest and back pains coupled with pain in the jaw, which at times were excruciating. “Madalas kong maramdaman ang pain mula sa dibdib hanggang likod, pati ngipin ko sumasakit,” Dumaguit added.

When the pain persisted for months and there was no sign of abating, she decided it was time to visit her doctor. An angioplasty was first conducted early last year to fix her blocked arteries. Six months later, she was operated on for CABG at the PHCA. She was initially apprehensive not just because of the operation but knowing that the surgery itself would cost a fortune.

Her initial fear was unfounded because she realized she had PhilHealth, which covers CABG operation for P550,000 under the Z Benefit. The bypass operation conducted on her went without a hitch although she paid an additional amount since she opted to stay in a private room. “Nagpapasalamat pa rin ako kasi sinagot ng PhilHealth ang malaking porsiyento ng ginastos ko sa pagpapa-opera, malaking bagay na sa akin iyon,” Dumaguit happily shared.

“Hole in the heart”

She works as a masseuse. Elena Peligro, 33 and blind since birth, was teary-eyed as she recounted that fateful day when they found out that her daughter, Lea Jane, 3, was suffering from a ventricular septal defect (VSD), which, as explained to her is a “hole in the heart.”

VSD is one of the most common congenital heart defects. Elena and her family, who resides in Bicutan, Taguig, was devastated because they did not have any means to afford medical expenses that was sure to be incurred should they seek treatment.

Having no health insurance coverage at the time her daughter was admitted, Peligro was eventually enrolled under PhilHealth’s Point-of-Care after being assessed by the hospital’s social welfare office. “Kahit kapos po kami sa pera hindi na kami nagdalawang-isip na ipa-opera si Lea para madugtungan ang buhay niya,” Peligro said.

As a beneficiary of the No Balance Billing policy, Elena did not pay any single centavo upon checking out of the hospital after nine (9) days of stay. “Sobrang natuwa po kami kasi wala kaming binayaran ni isang kusing,” Peligro further said. She later learned that PhilHealth subsidized the payment for the VSD procedure for P250,000 and because of this she profusely expressed her deep gratitude to the program. “Laking pasasalamat ko sa PhilHealth at naging miyembro ako agad at natulungan kami sa oras ng kagipitan.” Lea now is a precocious and active little girl who does not look like she went through a life-threatening ordeal.

“Not that common”

John Kian Calub, 3, was just like any other kid his age, always full of energy, but he was experiencing persistent cough and colds. His parents, Jennifer, 33 and Wilfredo, 38 and an electrician, thought nothing of it.

But what they originally thought was common cough and colds turned out to be not common after all. They were advised by the doctor to bring John Kian to the PHC for further tests because initial findings showed that he had heart murmurs. The husband and wife were surprised to learn that their precious son was suffering from a serious heart ailment and that it could be fatal if not treated early. They wasted no time in having John Kian admitted at the PHC in preparation for surgery for Tetralogy of Fallot for which PhilHealth pays P320,000 under the Z benefit package.

“Hindi na po kami nagdalawang-isip na ipa-opera siya kasi tiwala kami sa mga doktor at sa PhilHealth na matutulungan kami,” Jennifer said. It was really a good thing that both the patient’s parents are PhilHealth members and knew of PhilHealth’s Z benefit through the doctor that initially treated John Kian. “Alam ko po na kapag PhilHealth member ka, sagot nito ang pagpapa-ospital mo, hindi ko lang sigurado dati kung magkano,” she added. As it turned out, the operation had been at no cost to them since they availed of the NBB policy.

“Full subsidy”

These are just some of the stories from beneficiaries of PhilHealth’s Z benefit packages that may be availed in hospitals contracted by PhilHealth to conduct those kinds of surgical procedures for members of the program. The PHC is a contracted government hospital to provide Z benefit packages for heart diseases such as CABG, TOF and VSD. The hospital strictly implements the NBB policy of PhilHealth especially if the patient passes through the social welfare’s evaluation and stays in a charity ward.

However, if patient-members opted to stay in a private room, an additional out-of-pocket expense may be charged against them. “Since the PHC is a contracted hospital of PhilHealth for the Z benefit packages, we really implement the no balance billing policy strictly,” Dr. Juliet Balderas, a Pedia Cardiologist, attested. When asked if the PhilHealth payment is sufficient to cover the cost of the procedures, Balderas said, “whether the cost of the procedure conducted on a patient-member exceeds the amount of what PhilHealth pays for that benefit package, the PHCA does not charge the patient anything.” The PHC or a foundation pays for the excess cost for charity patients and even for pay patients.

“Movers and shakers”

Leading the pack of doctors in PHC who are considered as the “prime movers” of PhilHealth’s Z benefit implementation are Dr. Gerardo Manzo, PHC Assistant Director, Drs. Maria Teresa Abola, Adult Cardiologist; Juliet Balderas, Pedia Cardiologist; Francois Mae Sarmiento, Assistant Chair for Clinical Pathways; and Virginia Mappala, Pedia Coordinator for Clinical Pathways.

“Under the no balance billing policy of PhilHealth, a patient does not pay a single centavo during his or her admission because the PHC utilizes and strictly follows the approved clinical pathways for this procedure,” Manzo explained. Implementing clinical pathways means standardization of care processes, and treatment regimens are standardized to be able to improve the efficiency in the use of the hospital’s resources and finish work in a set time. (END) (Amelita L. Buted)