What is No Balance Billing and what if I was charged anyway?
Last updated: 2026-07-11 · Educational content; not legal advice.
Short answer
No Balance Billing (NBB) means a qualified member in ward or basic accommodation at a public hospital should have zero out-of-pocket cost for PhilHealth-covered services — no other fee or expense may be charged above the package. The categories traditionally covered are indigent (DSWD-identified) members, sponsored members, and senior citizens confined in the basic/ward accommodation of government facilities; the policy is set out in PhilHealth Circular No. 2020-0024 and rooted in the Universal Health Care framework. Hospitals are supposed to apply it automatically. You may also see this called Zero Balance Billing (ZBB), the government's push — reported through 2025 and 2026 — to widen the guarantee so that all PhilHealth members in basic or ward accommodation of DOH-retained hospitals pay nothing for covered services; treat the wider version as reported rather than settled, and confirm your own eligibility at the hospital's PhilHealth desk. Here is the part that catches people out: hospitals are supposed to apply this automatically, and the bill alone will not tell you whether they did. It breaks down in specific, recognisable ways — the pharmacy is out of a drug so you are sent to buy it outside, items are labelled 'not covered' or above the case rate, or you are moved out of the ward into a higher accommodation, which can void the guarantee. So if you paid anything at all, ask the billing or PhilHealth desk for a written breakdown of the charges against the applicable case rate and which items are claimed as not covered — that document is what any complaint is built on. Then file with the PhilHealth Corporate Action Center, which can audit the deduction, order a refund and sanction the provider. LabanPH will write that dispute letter for you, free and without an account, at labanph.org/complaints/build.
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Frequently asked
Who is entitled to zero out-of-pocket under NBB?
Traditionally: indigent members identified by DSWD, sponsored members, and senior citizens, when confined in the basic or ward accommodation of a government (public) facility, for PhilHealth-covered services. Kasambahay (household helpers) are also covered by circular. The government's 2025 Zero Balance Billing push has been reported to widen this so that all PhilHealth members in basic/ward accommodation of DOH-retained hospitals pay zero for covered services — confirm your specific eligibility at the hospital's PhilHealth desk.
What is Zero Balance Billing, and is it the same as No Balance Billing?
They are the same guarantee under two names, with the newer one describing a wider version of it. No Balance Billing is the long-standing PhilHealth policy: qualified members in basic or ward accommodation at a government facility pay nothing out of pocket for covered services. Zero Balance Billing is how the government's more recent expansion of that guarantee is described, reported as extending it to all PhilHealth members in basic or ward accommodation at DOH-retained hospitals. Reporting through 2025 and 2026 describes it operating at DOH-retained hospitals, including patients receiving surgery with no out-of-pocket cost. Two honest cautions: we have not been able to pin the governing DOH memorandum-circular, so treat the wider coverage as reported rather than confirmed; and either way it applies to basic or ward accommodation at government facilities, so a private hospital, or a room upgrade, changes the answer. Ask the hospital's PhilHealth desk to confirm your own eligibility before you are admitted, not after you are billed.
Where does NBB commonly break down?
You can be pushed out-of-pocket when the hospital runs out of a drug or supply and tells you to buy it outside, labels items 'not covered' or above the case-rate package, or moves you out of the ward (even involuntarily) into a higher accommodation, which can void NBB. NBB is fundamentally a public-facility guarantee — private hospitals apply the case-rate deduction but not zero balance.
What do I do if I was charged despite being NBB-eligible?
Ask for a written breakdown of the charges versus the applicable case rate and which items are claimed as 'not covered.' Then file a written complaint with any PhilHealth office or the Corporate Action Center (actioncenter@philhealth.gov.ph, (02) 8662-2588). Any person may complain about an over-deduction or NBB violation, and PhilHealth can order a refund and sanction the provider. LabanPH can build the dispute letter.
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