This comes as the Philippines takes part in World AIDS Day on Tuesday and amid a reported rise in the number of HIV/AIDS cases.
PhilHealth said it seeks to reduce the number of HIV/AIDS-positive Filipinos by strengthening information campaign, publicizing specific benefits and assistance that patients can get from the social insurance program.
“We provide benefits for these people living with HIV through our benefits, the facilities. The treatment hubs can use this to disseminate information, counsel these people,” said Dr. Mary Antoinette Remonte, Millennium Development Goals Benefit Products Team head at PhilHealth.
Remonte said one of the reasons why HIV cases have been increasing is due to low awareness of the illness.
She said this problem eventually propagates stigma that push infected people to hide their condition instead of undergoing screening or getting treatment.
Remonte said PhilHealth has the Outpatient HIV/AIDS Treatment (OHAT) package that covers anti-retroviral treatment (ARV) and laboratory exams based on specific treatment guideline (CD4 determination, viral load test, drug toxicity test and professional fees of providers).
“Philhealth benefit is just an additional support to control the disease. So usually it is used for laboratory tests then for counseling. Then as a support to those who are giving care to the patients,” she said.
The doctor explained that the package covers up to P30,000-worth of necessary medical expenses per member-patient per year.
She said the benefit is a case-based payment; that for every patient with HIV, PhilHealth pays a maximum of P30,000 per year without cap on how many times the patient will go to treatment hubs and how many medicines or tests the patient will avail, as long as it falls within the given amount.
However, Remonte said the patient has to pay from his or her own purse if the cost of the treatment already exceeded the amount of PhilHealth's support.
She added that the coverage of OHAT package goes in accordance with the guidelines set by the Department of Health (DOH).
Meanwhile, Remonte said PhilHealth's hospitalization benefits for PLHIVs can range from P11,000 to P20,000 depending on the case.
“Usually, a person with HIV is not admitted to a hospital due to HIV. They are admitted because they have infection or they have cancer associated with HIV. And with that, we have corresponding amount or benefit for each case,” Remonte said.
HOW TO AVAIL OF OHAT
Remonte said patients who want to avail of the OHAT package need to be screened first and have the confirmation that they really have HIV.
She said the screening and prescription of ARV treatment should be determined by a DOH-designated treatment hubs.
“It’s the treatment hub who will enroll them to the treatment and will file the claim to PhilHealth,” she said.
As for the documentary requirements, Remonte said a patient should have the following: copy of PhilHealth ID, waiver allowing PhilHealth to look into the patient's records, copy of treatment regimen, and HIV confirmatory result.
For individual and employed members, Remonte said three to six months contribution is required before they can avail of the benefits, while members who pay premiums annually are covered as long as their membership is still valid.
TREATMENT HUB ISSUES
Currently, there are 22 hospitals that are designated treatment hubs all over the country.
Remonte said there are also satellite clinics in different parts of the country that provide some of the services needed for HIV treatment.
As HIV cases are growing, the PhilHealth medical specialist said the DOH has planned to expand the number of facilities.
However, Remonte admitted that the cost of laboratory tests or medical services varies across treatment hubs. She said the hubs have different ways of applying the support provided by PhilHealth.
But Remonte assured that the agency acts on complaints over reported violations by treatment hubs, citing reprimand and withdrawal of accreditation as penalties.
For a patient to get what he or she is entitled to, Remonte said they can check if the treatment hub is filing their claim with PhilHealth, adding they can write a complaint to the agency with full confidentiality or anonymity.
The doctor said HIV patients can also turn on their website at www.philhealth.gov.ph to access more information about various supports they can avail of.
Despite the issues, Remonte urged the public to help in the efforts of controlling the spread HIV/AIDS.
“HIV is increasing in our country and we do something about it. Be educated. For those with what they call risky behavior, have yourself tested so you could be treated right away because a person living with HIV actually can have a normal life,” she said.
SOURCE: (ABS-CBNnews.com)