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[Hospital Letterhead]

[Hospital Name]

[Hospital Address]

[Contact Number and Email]

[Date: March 23, 2026]

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that Patient AA (PhilHealth ID: [Insert ID if known], Age: [Insert Age], Address: [Insert Address]) was admitted to [Hospital Name] as an urgent case requiring Coronary Artery Bypass Graft (CABG) surgery due to severe ischemic heart disease (IHD).

Initially classified as an urgent but non-emergent case, the patient was evaluated for potential availment under the PhilHealth Z-Benefit Package for Open Heart Surgeries (CABG). However, the patient did not qualify for immediate availment of this package under the existing implementing rules and regulations, primarily because:

• The case was initially assessed as urgent (not meeting the strict elective/stable criteria for pre-authorization in the standard Z-Benefit CABG package, which typically requires stable coronary artery disease, specific risk stratification (e.g., EuroSCORE), and pre-authorization for elective isolated CABG in patients aged 19-70 without severe decompensation).

• A deficient down payment (co-payment or required deposit policy of the facility) prevented proceeding with the scheduled surgery at that time.

Consequently, the surgery was deferred. During the period of delay, the patient's condition deteriorated, resulting in the development of acute myocardial infarction (AMI), thereby converting the case into a true emergency requiring immediate intervention.

The patient subsequently underwent emergency CABG with intra-aortic balloon pump (IABP) support. The procedure was successful, with the patient achieving hemodynamic stability and eventual discharge last week ([insert approximate discharge date, e.g., March 15, 2026]).

Despite the successful outcome, the patient is currently unable to settle the remaining hospital bills due to significant outstanding balances. The patient cannot avail of zero hospital balance (no balance billing) or full coverage under the Z-Benefit package retroactively in this context, owing to:

• Lack of pre-authorization under the standard Z-Benefit CABG guidelines (which are oriented toward elective/urgent but non-emergent cases).

• Absence of specific implementing rules and regulations explicitly covering emergency CABG conversions from urgent cases, particularly those involving progression to AMI and requiring IABP, with provisions for waiving down payments or applying no-balance billing in such transitional scenarios.

• Non-inclusion or non-application of the IHD-AMI PhilHealth benefit package to cover the full CABG procedure in this emergency evolution (noting that IHD-AMI packages primarily support PCI, fibrinolysis, emergency transfer, and rehabilitation, but do not fully integrate with emergency open-heart surgery packages).

This certification is issued to support any request for compassionate consideration, financial assistance, appeal for exceptional coverage, or policy clarification from the Philippine Health Insurance Corporation (PhilHealth) and/or the Department of Health (DOH) regarding possible retroactive application, waiver of balances, or amendment to implementing guidelines to address similar life-threatening transitions from urgent to emergent cardiac surgical needs without financial barriers.

The medical team attests that all clinical decisions were made in the best interest of the patient, aligned with evidence-based standards for acute coronary syndromes and emergency cardiac surgery.

For any verification or further inquiries, please contact the undersigned or the hospital's PhilHealth Desk.

Issued this 23rd day of March 2026 at [City], Philippines.

Attending Physician / Cardiovascular Surgeon

[Full Name, MD]

[PhilHealth Accreditation Number, if applicable]

[Signature over Printed Name]

Noted by:

Chief of Cardiology / Department Head

[Full Name, MD]

[Signature over Printed Name]

Hospital Director / Authorized Representative

[Full Name]

[Signature over Printed Name]

[Hospital Dry Seal]

This document is issued free of charge and solely for official purposes related to PhilHealth claims, financial assistance, or policy review.