• CHERYL G. CRUZ
The Philippine Health Insurance Corporation said it has paid P4 billion in benefit claims to accredited healthcare facilities in Bacolod City and Negros Occidental, and processing the release of P782.8 million, as of Sept. 30 this year.
In a media briefing in Bacolod City Nov. 7, Janimhe Jalbuna, head of PhilHealth Region 6 Public Affairs Unit, said that 24,122 claims, worth P395 million, were returned to hospitals (RTH) due to various reasons or defects, while 12,584 others, worth P102 million, had been denied, also for varied reasons, like being filed after the deadline, or the patient unregistered in the PhilHealth dialysis database.
The paid claims in Negros Occidental were second highest in Western Visayas, next to Iloilo, with 309,012 claims settled, worth P4.5 billion, also for the same period.
PhilHealth said top paid illnesses in the region, as of Sept. 30, were pneumonia moderate risk, P851 million; stroke infarction, P347 million, high risk pneumonia, P220 million; hypertensive emergency, P209 million; and dengue fever, P178 million.
Top paid procedure, on the other hand, were hemodialysis, P2.8 billion; primary caesarian section, P287 million; routine obstetric care, including antepartum care, P258.9 million; chemotherapy administration, P258.8 million; and expanded newborn package, P208 million.
There are 3,049,146 registered PhilHealth members and dependents in the highly-urbanized city and the province, or 94.50 percent, of the total 3,219,739 population; with 45 accredited healthcare facilities, including hospitals, and freestanding dialysis clinics (FDCs) all over Negros Occidental.
The membership registration in Negros Occidental is already high, PhilHealth officials said, adding they are now focusing to increase the number of enrollees in the YAKAP, or Yaman ng Kalusugan Program.
YAKAP registration in Bacolod City and Negros Occidental reached 307,723 PhilHealth members and 727,271 dependents, or 32.15 percent.
Jalbuna and PhilHealth-Bacolod head Edgar Yocariza called on other PhilHealth members to also register in YAKAP to avail of services from accredited providers.
“YAKAP builds on the foundations laid by the Konsulta Program, representing its next phase of development,” said Dr. Amalia Fernandez, who discussed the benefits and availment process during the forum. “The program primarily integrates primary care services with outpatient laboratory diagnostics and pharmaceutical benefits, and refines the model by expanding access points, improving provider incentives, and strengthening care coordination.”
Those who registered in YAKAP can avail of free checkup, laboratory tests, or cancer screening tests from accredited package providers, and P20,000 worth of free outpatient medicines under the GAMOT, or Guaranteed and Accessible Medications for Outpatient Treatment, for each member or dependent.
There are 49 accredited YAKAP package providers in Negros Occidental, including three in Bacolod – the Corazon Locsin Montelibano Memorial Regional Hospital, the Bacolod City Health Office, and the Medisense Laboratory Center Inc. | CGC
