PhilHealth orthopedic package covers up to ₱260,000 in implants; 2 providers in Central Visayas

CEBU CITY — Patients in Central Visayas who need major orthopedic procedures can access PhilHealth’s Z Benefit for Selected Orthopedic Implants through two contracted hospitals in the region, as the state insurer and orthopedic specialists push for greater public awareness of the package.

CONTRIBUTED PHOTO

Of the 27 hospitals contracted nationwide to provide the orthopedic implant benefit, two are located in Central Visayas: the Gov. Celestino Gallares Memorial Medical Center (GCGMMC) in Bohol and the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu.

The benefit covers a range of orthopedic procedures involving the hip, knee, upper extremities, and fractures, with implant coverage reaching as much as ₱260,000 for a cementless total hip prosthesis.

The package is intended to help reduce the financial burden of orthopedic procedures, particularly for patients requiring joint replacement or surgical fixation following fractures.

The Philippine Health Insurance Corp. (PhilHealth), together with the Philippine Orthopedic Association (POA), Philippine Hip and Knee Society (PHKS), and GCGMMC, highlighted the benefit during a press conference held Sept. 11 at the GCGMMC in Tagbilaran City.

The activity was part of a nationwide roadshow aimed at increasing awareness of advances in hip and knee replacement surgery and informing patients about available PhilHealth coverage.

PhilHealth Regional Office VII Acting Regional Vice President Jenet Ann Advincula joined representatives from the orthopedic groups and GCGMMC in discussing access to orthopedic care and the social health insurance coverage available under the Z Benefit.

The orthopedic implant package includes coverage for several types of hip arthroplasty, including cemented total hip prostheses at ₱210,000, cementless total hip prostheses at ₱260,000, bipolar partial hip prostheses at ₱230,000, and hybrid total hip prostheses at ₱230,000.

For hip fixation, the benefit covers multiple screw fixation worth ₱160,000. Procedures for pertrochanteric fractures include compression hip screw sets at ₱150,000, as well as proximal femoral locked plates and proximal femoral nails at ₱160,000 each.

For femoral shaft and tibial fractures, the package covers intramedullary nails with interlocking screws at ₱140,000 and locked compression plates at ₱150,000.

The benefit also covers total knee replacement, with a knee prosthesis package valued at ₱251,000.

For upper-extremity procedures, coverage includes arm and forearm plating at ₱117,000, arm and forearm pinning at ₱100,000, wrist plating at ₱124,000, and wrist pinning at ₱106,000.

POA representative Dr. Michael Muñoz expressed appreciation for PhilHealth's support of orthopedic specialists and their efforts to expand access to treatment.

PHKS representative Dr. Herminio Valenzuela, meanwhile, cited the direction of PhilHealth and the Department of Health toward broader access to healthcare.

“If you see what PhilHealth and DOH [are] doing, it’s moving towards inclusive healthcare. It veers away that healthcare is a privilege, but a basic right. That is what we are thankful for, to achieve quality and affordable healthcare,” he said.

Under the program, PhilHealth contracts Level 2 and Level 3 hospitals that apply to become Z Benefit providers and meet requirements for equipment, qualified orthopedic specialists, and other essential healthcare services.

The requirements are intended to ensure that contracted facilities have the capacity to provide orthopedic procedures covered by the package.

With GCGMMC in Bohol and VSMMC in Cebu serving as the region's two contracted providers, PhilHealth and orthopedic groups are encouraging greater public awareness of the benefit, particularly among patients who may otherwise find the cost of implants and orthopedic surgery prohibitive.