PhilHealth Benefits for Breast Mass Excision

The PhilHealth benefits for “excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion or nipple lesion, (except for gynecomastia), male or female, one or more lesion” consist of the following:

  • Health care institution fee: P5500
  • Professional fee: P2520

My recent experience (2016 Jan) with Manila Doctors Hospital Operating Room Complex showed that the hospital expenses can be fully covered by the PhilHealth benefits.

Total hospital expense: P5224.66 [breakdown into: operating room complex expense: P2960.98; pharmacy: P103.68; and laboratory (histopath): P2160.00].

Operation done: excision of breast mass under local anesthesia and outpatient

My perception is that in most private hospitals, most patients with PhilHealth still shell out money to pay hospital expenses as these usually exceed the PhilHealth case rates.  The no-balance-billing is not applicable to private hospitals.

I and my patient are happy that the PhilHealth benefit was able to cover the hospital expenses of the breast mass excision.  (Note: there is still an excess of about P300 on the PhilHealth benefit which automatically goes to the hospital.)

The trick in keeping the hospital expenses of a patient within the limit of the PhilHealth case rate consists of being aware first of the amount of PhilHealth benefit and then compassionate maneuvers to be done by the surgeon in keeping the cost down without necessarily sacrificing the quality outcome of the operation.  Examples of such maneuvers: avoiding excessive use of sponges; keeping the operation minimally bloody as much as possible; avoiding use of surgical equipment and materials that are not strictly needed; use of inexpensive sutures; etc.

It goes without saying that the key contributor to keeping the hospital expenses within the PhilHealth benefits is the surgeon.



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9 Responses to PhilHealth Benefits for Breast Mass Excision

  1. reyojoson says:

    Comments from Carol Nunez (gotten from rjoson_health_advisories): Doc Rey,
    The most important statement in your email is the last sentence! I suggest that those in this e-group pass this info onto their friends and, should the need arise, appeal to the surgeon’s compassion.

    Thank you for this information and I hope other surgeons agree and welcome the practice.

    Carol N. 16jan6

  2. Jan says:

    I also have cyst. But my doctor dont to rem9ve it becuase benign. I like to remove it. I have maxicare and philhealth. Can you help me with this? Thanks.

  3. reyojoson says:

    Tue Thur 10-12 Sat 9-11. Yes. Accepting Maxicare. Email:

  4. Juvylyn Onacin says:

    Doc may breast lump ako? Paano ko kaya mapapatanggal at magkano?

  5. Joy Chua says:

    Dr. Joson,

    Ask ko lang po kung magkano na yung cost ng breast mass excision? Nalaman ko lang po kasi kahapon na may bukol pala sa left breast yung nanay ko.
    Yung discussion nyo po is very helpful. I hope doc pwede nyo rin po akong matulungan. Maraming salamat po at God bless!

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