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. If you were charged anyway, ask the billing or PhilHealth desk for a written breakdown of the charges against the applicable case rate, then file a written complaint with the PhilHealth Corporate Action Center, which can audit the deduction and order a refund.
Primary sources
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.
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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