What is Coronary Artery Bypass Grafting (CABG)?
Coronary Artery Bypass Grafting also known as CABG (pronounced “cabbage”) is a surgical procedure that seeks to provide an alternative flow of blood to a portion of the heart that is at risk of disease because of a narrowed or blocked blood vessel. This is done by taking healthy blood vessels from either the chest or the legs and connecting them in such a way that the area of the heart that is at risk is sufficiently resupplied with blood. The Medical City South Luzon’s team of specialists has performed many of these procedures safely and with excellent outcomes even during the course of the COVID-19 pandemic.
PhilHealth Z-Benefits for Coronary Artery Bypass Grafting (CABG) in TMCSL
In August of 2023, the Philippine Health Insurance Corporation (PhilHealth) has officially recognized The Medical City South Luzon as an accredited hospital for Z Benefit-eligible patients in need of Coronary Artery Bypass Grafting (CABG) making it THE VERY FIRST Z BENEFIT ACCREDITED HOSPITAL IN LAGUNA for this type of procedure. This accreditation is given only to healthcare institutions that have a proven record of commitment to safety and excellent outcomes in the delivery of this very delicate
operation.
What are the PhilHealth Z Benefits?
The Z-Benefits make up the monetary subsidy given by the PhilHealth to cover a portion of the cost of treatment for patients that fall under “Case Type, Z”. These are the patients with potentially catastrophic conditions in whom absence of treatment or intervention will mean poor outcomes with extended hospitalization or even untimely death.
The selection of these conditions is based on reliable clinical evidence that point to how certain types of treatment or interventions can significantly improve if not reverse the course of what could have been a poor or even fatal outcome for any given patient. Included among these are cardiovascular conditions that require Coronary Artery Bypass Grafting (CABG).
Who are eligible to avail of the PhilHealth Z-Benefits for Coronary Artery Bypass Grafting (CABG)?
Presently, TMCSL selects patients who have been assessed as having STANDARD RISK by an attending cardiologist in an OUTPATIENT setting as potential candidates PhilHealth Z-Benefit availment.
These patients shall then be referred to and assisted by the Nurse Case Manager who will help them complete the documents required by PhilHealth for Z-Benefit eligibility. During this time, the Nurse Case Manager will also convene the Clinical Risk Screening Committee (CSRC) which is tasked with deciding whether CABG performed on these patients would result in a favorable outcome.
What does PhilHealth require in considering a candidate eligible to receive Z-Benefits for Coronary Artery Bypass Grafting (CABG)? A patient is required to submit the following documents to the Nurse Case Manager:
· Member Data Record (MDR) Form
· Pre-Authorization Checklist and Request (signed by the patient, attending cardiologist, cardiac surgeon, and chief medical officer)
Upon submission of the complete set of documents by the patient and their verification by the Nurse Case Manager, these shall then be sent to the PhilHealth Local Health Insurance Office (LHIO) in Calamba, Laguna, after which, the APPROVED Pre-Authorization Form from PhilHealth will be returned to the Nurse Case Manager who will then process the request and assist the patient in accomplishing additional documentary requirements.
Once the documentary requirements have been accomplished, the Nurse Case Manager shall now notify the team of physicians who will treat the patient and schedule the date of the patient’s admission and surgery.
How much is the patient’s share in the total cost of Coronary Artery Bypass Grafting (CABG) in TMCSL?
From the estimated cost of Php 1,100,000, PhilHealth shall provide a subsidy of Php 550,000 or 50%. The share or “co-pay” of STANDARD RISK patients shall not exceed the subsidy of PhilHealth. This means a standard risk patient will be paying an amount of Php 550,000 inclusive of doctor’s fees and postoperative cardiac rehabilitation.
TMCSL’s status as a Z Benefit accredited hospital for standard risk Coronary Artery Bypass Grafting (CABG) is a testament to its commitment both to safety and excellence in clinical outcomes for its patients as well as its commitment to help the common man cope with the cost of treatment for this life saving procedure.
