The Philippine Health Insurance Corporation (PhilHealth) in Negros Oriental has disbursed P469,208,060 as payment for hospital and other medical services claims in the province as of Dec. 31, 2024.
This was disclosed by PhilHealth Negros Oriental administrative officer Sheila Marie Bacalso in a recent Kapihan sa PIA forum in Dumaguete. Bacalso siad the amount benefitted 45,295 members in the province.
However, she noted that the figure only represented the claims that were paid in government hospitals and local health units in the province.
PhilHealth claims refer to the requests for financial assistance for their medical bills filed by patients or their guardians to the agency.
Pneumonia illnesses topped the list of medical cases with the highest number of claims paid by PhilHealth in the province with P350,726,411 disbursed to 20,171 patients.
Dengue illnesses ranked second on the list with P206,683,644 disbursed to 17,441 patients.
Meanwhile, hemodialysis topped the list of packages and medical procedures availed by PhilHealth members with P361,138,322.71 disbursed to 57,869 patients.
This was followed by expanded new born care package with P361,138,322.71 disbursed to 57,869 PhilHealth members.
Bacalso also said the PhilHealth board also approved the release of P8 million to pay for unpaid claims filed by 614 members for December 2024.
The PhilHealth official underscored that these accomplishments are testaments to the agency’s sincerity in providing health insurance that shields Filipinos from the financial burdens of illnesses and hospitalization.
“Starting January 2025, PhilHealth launched additional and expanded health benefit packages including coverage for ischemic heart disease-acute myocardial infarction, Z packages for peritoneal dialysis and kidney transplantation, preventive oral health services, outpatient emergency care, and a 50 percent increase in case rate packages,” Bacalso said.
PhilHealth’s hemodialysis package was increased from P4,000 to P6,350 for 156 sessions annually.
Kidney transplantation “Z Benefit Package” also increased from P865,000 to P2,093,000, but Bacalso clarified that this can only be availed in PhilHealth-contracted hospitals, of which there is currently none in Negros Oriental.
Patients will be referred to Vicente Sotto Memorial Medical Center (VSMMC) or to Perpetual Succor Hospital in Cebu City, which are the accredited hospitals to facilitate the “Z Benefit Package,” which is intended for patients with catastrophic illnesses.
PhilHealth’s medical package for ischemic heart disease-acute myocardial infarction or heart attack also increased from P21,900 to P523,853. Case rate adjustments will also be carried out starting this year.
For example, the rate for moderate risk pneumonia was increased from P15,000 to P29,250, cesarean section from P19,000 to P37,050, and cholecystectomy from P31,000 to P60,450, cataract extraction from P20,200 to P187,100 per eye from P16,000 per eye.
Aside from enhancing their comprehensive packages, PhilHealth also streamlined several processes and policies including the elimination of the single period of confinement policy, inclusion of foster children as dependents for solo parents, and the active enforcement of “No Co-Payment Policy” for patients in basic or ward accommodations in accredited government and private hospitals.
“These initiatives aim to provide more accessible and affordable healthcare services to all Filipinos, ensuring that everyone has access to quality health services without the financial strain,” she said.
PhilHealth records show there are more than 1.2 million members in Negros Oriental divided into direct contributors or those who are employed members, and the indirect contributors who are members that were enrolled with PhilHealth through government programs and initiatives. | NWI
