PhilHealth reviews claims, tightens monitoring systems

PhilHealth said it is strengthening monitoring and auditing systems following reports of discrepancies between information given to patients and claims submitted by healthcare providers.

The agency said it is reviewing cases where patients were allegedly misinformed about their coverage, while providers submitted different claims.

PhilHealth reported that it paid out P300.45 billion in benefits in the past year, an increase of 81.72 percent from the previous year.

It said the review forms part of efforts to improve transparency and ensure members receive the benefits due them under the Universal Health Care program, which covers primary care, emergency outpatient services, and inpatient care.

Patients and their families are advised to ask healthcare providers about PhilHealth coverage, request itemized billing, and verify benefits before settling accounts.

Members may also consult PhilHealth CARES representatives in hospitals for assistance.

PhilHealth said member feedback will be used to support ongoing reviews and improve services.

For inquiries, members may contact PhilHealth through its official hotline at (02) 8662-2588 or via email at actioncenter@philhealth.gov.ph.

The agency also acknowledged remarks by Ombudsman Jonvic Remulla, saying the concerns raised reflect ongoing issues being addressed.