Lawmaker claims hospitals not honoring new PhilHealth benefit
A House lawmaker has called out the Philippine Health Insurance Corp. (PhilHealth) amid complaints from some patients over its alleged failure to implement its Outpatient Emergency Care Benefit (OECB) package, more than a month after its effectivity.
“We do not want fake news, especially when it comes to health-care services. We should not give false hope about benefits to our fellow citizens who have long been deprived of the services they rightfully deserve—especially when PhilHealth has billions in funds to provide them,” Agri Rep. Wilbert Lee said in a statement.
Lee wrote a letter addressed to PhilHealth president and CEO Dr. Edwin Mercado seeking clarification on the issue.
In his March 23 letter, the party list representative cited the billing statements of two patients in two hospitals where PhilHealth coverage for their emergency room expenses were both zero, reflecting that the OECB package was not honored or implemented.
“It is regrettable and unacceptable that despite the official announcement of PhilHealth, this ‘outpatient emergency care service’ is neither operational nor available to PhilHealth members in several, if not all hospitals across the country,” Lee said.
In a message to the Inquirer on Thursday, PhilHealth insisted that all members can avail of the OECB package in all Level 1 to 3 accredited hospitals starting Feb. 14.
No separate accreditation
“It is also reiterated in PhilHealth Advisory No. 2025-0009 … that a separate accreditation is not required to deliver the OECB package, as the capability of health facilities for this benefit was already assessed when they were granted PhilHealth accreditation,” it said.
As of Feb. 28, there were 1,816 PhilHealth-accredited hospitals and infirmaries, both public and private, nationwide.
PhilHealth directed the public to report accredited hospitals that do not provide the OECB package to (02) 8662-2588; mobile numbers 0998-8572957, 0968-8654670, 0917-1275987 or 0917-1109812.
The OECB package covers all outpatient services and commodities rendered at the emergency department (ED) and extension facilities in PhilHealth-accredited health-care facilities, including services provided before arrival or during transport to a hospital.
The package also covers patients who do not require hospital admission and are discharged within 24 hours after entering the ED, or died while in the ED.
Among the cases covered in the OECB package are dizziness, diarrhea, persistent vomiting, elevated blood pressure, nontraumatic bleeding, seizures, severe headache and sexual assault.
