CAGAYAN DE ORO (PIA) — The Philippine Health Insurance Corporation (PhilHealth) is focusing on internal reforms to rebuild trust among members and healthcare providers.
Merlyn Ybañez, public relations head of PhilHealth in northern Mindanao, discussed the agency’s efforts to reduce administrative workload, enhance service delivery, and regain confidence from stakeholders during the Regional Association of Government Communicators (RAGCOM) Forum on Universal Healthcare.
“We’re simplifying systems, processes, and paperwork internally and externally,” Ybañez said.
She highlighted the improvements in claims processing, the reduction of red tape, and the adoption of digital tools to improve efficiency.
After reconciling with hospitals and healthcare providers, PhilHealth has reduced the turnaround time for valid claims to 14 days. “It’s not about PhilHealth’s utang to hospitals,” Ybañez clarified. “The good claims, nabayaran sila.” (The good claims are being paid.)
Ybañez also addressed concerns related to a Supreme Court case involving premium subsidies. She assured the public that benefits remain unaffected, with only the premium contributions of indirect contributors impacted by budget limitations. This includes indigent members, Pantawid Pamilyang Pilipino Program beneficiaries, senior citizens, and persons with disabilities.
Meanwhile, PhilHealth updated its benefit packages under Circular No. 2025-0007, lifting the 45-day annual hospital confinement limit. This applies to all medical conditions, surgeries, and special packages under the All Case Rates payment mechanism at accredited health facilities. The Dialysis Benefit Package remains capped at 156 sessions per year.
Through Circular No. 2025-0006, PhilHealth will review previously denied claims due to late submission, provided the claims were received by PhilHealth within the extended filing timeframe.
Circular No. 2024-0025 allows members to file separate benefit claims for readmissions within 90 days for the same illness.
PhilHealth has also increased its budget for selected medical and procedural benefits by 50 percent for 2025.
Ybañez urged government agencies and RAGCOM members to help ensure the accurate dissemination of information to avoid confusion. (HSGA/PIA-10)
