PCCWI calls for quadruple increase in PhilHealth aid

The Philippine Coalition of Consumer Welfare Inc. (PCCWI) appeals to the state-owned Philippine Health Insurance Corporation (PhilHealth) to increase financial aid by fourfold to patients at private hospitals.

PCCWI founder and chairman Ricardo Samaniego suggests a bigger minimum aid that could be around P15,000 from a P3,000 to P4,500 deduction he said PhilHealth members usually receive.

"We have always the ear on the ground," he told DAILY TRIBUNE in a Viber message after attending a Senate hearing on PhilHealth last 10 September.

Samaniego requests that the PhilHealth support must include fees for expensive imaging tests like CT scans and MRIs.

While PhilHealth offers free consultations, medicines and laboratory tests through its Konsulta Package, he also said only a few accredited private hospitals and clinics are offering the package.

Samaniego said PhilHealth funds should help prevent financial and emotional burdens on patients, especially those with serious conditions who need advanced medical technologies private hospitals provide.

"One of the resource persons at the Senate hearing was a spouse of staff of a provincial health office in Camarines Norte. The patient who was suffering from cancer died at Makati Medical Center. Out of the total medical bill of P6 million, PhilHealth only shouldered P27,000," he said.

Samaniego said he will be talking with PhilHealth president and chief executive officer Emmanuel Ledesma Jr. as he was assured that his office is open to discussing PCCWI's suggestions.

As shared by Ledesma Jr. at the recent Senate hearing, PhilHealth Corporate Affairs Group acting vice president Rey Baleña said in a Viber message that the government insurer will further expand its benefits coverage for members by another 30 percent before the year ends.

In February, PhilHealth already raised benefits coverage by 30 percent for nearly all illnesses. In April, the government insurer expanded benefits for breast cancer patients by 1,400 percent from P100,000 to P1.4 million.

At that time, PhilHealth said there are only 21 PhilHealth-contracted facilities in over 1,400 municipalities nationwide that offer the breast cancer benefits package called the Z Package.

It now provides other types of therapy, apart from diagnostics, surgery and post-surgery surveillance for possible cancer recurrence.

"Because of the little benefits coverage in the past, hospitals thought it was not worth the trouble of processing the benefits package," Ledesma said in April.

The Senate hearing came after The Department of Finance (DoF) confirmed its order for a gradual return of P89.9 billion in unused funds of PhilHealth to the National Government.

Finance Secretary Ralph Recto, however, said the DoF is just being compliant with the General Appropriations Act of 2024 passed by lawmakers for the national budget. He said the government is looking to partly spend the unused funds on infrastructure projects.

Recto added PhilHealth still keeps a P500 billion reserve fund estimated to cover members' benefits over two to three years.

To encourage more private hospitals to become PhilHealth accredited partners, Samaniego said it must transmit payments to hospitals within 30 to 60 days. In case of delayed payments, he said PhiliHealth must pay interests as penalty.

PhilHealth senior vice president for Fund Management Renato Limsiaco Jr. said his team had already started coordinating with private hospitals to establish proper computation and recording of claims and streamline data systems. "Definitely, there are figures that will be different from those recorded by hospitals. But we already started reconciliation of data last year," he said.