PhilHealth banners feat

Source: mindanaoexaminernewspaper.blogspot.com

ZAMBOANGA CITY - The Philippine Health Insurance Corp. has bannered its accomplishments as far as health benefits of its members is concerned, saying 2023 had been a fruitful year for PhilHealth.

"Even without an increase in premiums, we were able to implement enhancements in benefits aligned with the commitment of the government of pinalawak at mga bagong benepisyo para sa mamamayang Pilipino," said PhilHealth president and CEO Emmanuel Ledesma Jr.

He said PhilHealth has institutionalized the coverage for hemodialysis to 156 sessions per year. "Many Filipinos, especially those suffering from Chronic Kidney Diseases Stage 5, lauded this move. In fact, the Dialysis Patients Group, Dialysis PH, expressed their sincerest thanks and message of continuing support to PhilHealth," Ledesma said.

Aside from the hemodialysis, he said PhilHealth also started rationalizing case rate for the most common cases being availed of by patients in the country and have significantly increased coverage for stroke, both ischemic and hemorrhagic, and high-risk pneumonia. On average, these 3 benefit packages have increased by about 150%, according to adding, PhilHealth also plan to rationalize six other case rates for the top cases or the most burdensome diseases and commonly availed cases among Filipinos. This is in accordance to our benefit plan in the next two years starting 2024.

"For us to be able to sustain these benefit enhancements, PhilHealth needs to continue strengthening its fund. Kailangan natin ng pondo para matugunan ang ating mga nasimulang magagandang pagbabago sa mga benepisyo ng PhilHealth," Ledesma said.

As provided for in Section 10 of Republic Act 11223 or the Universal Health Care Act, PhilHealth shall implement the last adjustment of premium contribution or the 5% contribution rate and income ceiling of P100,000 this year.

"As a key implementer of the UHC Law and one that administers the implementation of the National Health Insurance Program under the National Health Insurance Act of 2013, PhilHealth is bound to implement with what was mandated; otherwise, PhilHealth will be remiss in its duty to the Filipino people that the law intends to serve and benefit from. The law also prescribes that for every increase in the rate of contribution, PhilHealth shall provide for a corresponding increase in benefits," Ledesma said.

"Ang PhilHealth ay patuloy na tataya sa kalusugan ng bawat Filipino, kung kaya pinapalakas at pinagbubuti pa natin ang PhilHealth Konsulta Package. Ngayong taon, ang budget allocation natin para sa Konsulta Package ay 30 bilyon piso dahil layunin natin na ang bawat Filipino ay matingnan ng mga healthcare professionals at mabigyan ng serbisyo at gamot na kinakailangan," he added.

Ledesma said PhilHealth has published the guidelines for the implementation of GAMOT or the Outpatient Drug Benefit which will improve our coverage of outpatient medicines. The package increases the initial 21 medications covered by the Konsulta program to include an additional 32 other commonly prescribed outpatient medicines.

This will bring PhilHealth's coverage to a total of 53 outpatient medications, ranging from regiments covering infections up to maintenance medications for non-communicable diseases, according to Ledesma.

He said PhilHealth has paid a total of P45.1 billion to partner health facilities, both private and government, between the months of August and December of 2023 despite the cybersecurity incident in September.

The situation has impacted the stakeholders' receivables in the month of September and October, but PhilHealth was able to release payments of more than P12 billion in August and more than P10 billion in November, Ledesma said.

He said PhilHealth even exceeded in its commitment to settle its obligation with partner health facilities in 90 days.

"As we move forward, we plan to implement the following initiatives to address bottlenecks in claims processing. As an immediate solution, we will implement the claims system override support or SOS this month. Within the year, we are geared to launch various modules such as the cloud-based application system deployment, online filing for claims on motion for recommendation, adjustment module, to name a few. By 2025, as part of our long-term solution, we intend to deploy automated e-claims submission and processing via cloud base application system," he said.

Ledesma also appealed to partner health facilities to submit good claims and comply with the policies to avoid return or denied claims for we are bound by auditing rules and regulations of the government.

"We want to assure our partners that PhilHealth's doors are always open for communication and reconciliation of claims records. With all these developments, you can expect more from your PhilHealth. We need everyone's support to make all these happen."