MANILA – The Philippine Health Insurance Corporation (PhilHealth) has clarified that patients diagnosed with ischemic heart disease and acute myocardial infarction (IHD-AMI) are qualified to avail of the corresponding benefit package under PhilHealth Circular 2024-0032.
In an advisory issued Wednesday, PhilHealth said the policy guides all regional offices, accredited healthcare providers, and beneficiaries in filing, processing, and evaluating claims for IHD-AMI cases.
“All patients with acute myocardial infarction, including those with ST-elevation (STEMI) or non-ST elevation (Non-STEMI), may avail of the package,” the state insurer said.
“A non-specific or non-diagnostic ECG should not disqualify a patient from receiving the benefit.”
The advisory also emphasized that accredited health facilities without the capability to perform percutaneous coronary intervention (PCI) or fibrinolysis must coordinate and refer patients to hospitals capable of providing these services.
Referring facilities may still claim the “Emergency Medical Services with Coordinated Referral and Interfacility Transfer (IHD-AMI-C)” package.
They are also advised to refer patients for cardiac rehabilitation as part of their medical management, even if PCI or fibrinolysis is not performed.
Cardiac rehabilitation sessions may begin during hospital admission and continue on an outpatient basis.
Patients are required to complete at least six sessions provided on different dates, supervised by a cardiac rehabilitation specialist or, where unavailable, by a cardiologist in collaboration with a physiatrist.
PhilHealth encouraged health facilities to establish dedicated cardiac rehabilitation units but noted that the absence of such units should not hinder the delivery of rehabilitation services.
The state insurer also clarified that a 24-hour hospital admission is not required for reimbursement of IHD-AMI claims, emphasizing access to timely referral, early revascularization, and cardiac rehabilitation to improve patient outcomes.
“All accredited health facilities are encouraged to forge networks to improve access and address service gaps,” PhilHealth said.
It added that referrals to facilities with similar service capabilities are also acceptable and do not automatically require transferring patients to higher-level hospitals.
For inquiries, PhilHealth advised members and providers to contact its Corporate Action Center Hotline at (02) 8662-2588 or email actioncenter@philhealth.gov.ph. (PNA)