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MALASIQUI, Pangasinan – The Philippine Health Insurance Corporation (PhilHealth) paid PHP5.1 billion in medical and procedure claims in the Ilocos Region from January to July this year.
Citing agency data, PhilHealth Ilocos Region Vice President Dennis Adre, in a statement on Thursday, said moderate-risk pneumonia is the leading medical case in the region with a total of PHP381.7 million paid in claims in the first seven months this year.
Among the top medical cases that the agency has paid claims include hypertensive emergency, acute gastroenteritis, peptic ulcer disease without hemorrhage, urinary tract infection (admissible), dengue fever, upper respiratory tract infection, anemia, asthma in acute exacerbation, and respiratory failure, he said.
He said the hemodialysis, meanwhile, ranked first in the procedure claims with a total amount of PHP815 million paid.
The other procedures included are the expanded newborn care package; routine obstetric care including antepartum care; vaginal delivery and/or
postpartum care (normal spontaneous delivery package) for hospitals, with all services and supplies for the testing provided by the testing laboratory; chemotherapy administration; extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure/ e.g. phacoemulsification); caesarian section -primary, vaginal delivery only (with episiotomy); animal bite; and cesarian delivery.
Adre said PhilHealth implemented a 30 percent across-the-board increase in over 9,000 case rate packages this year, with another increase planned before the year ends.
‘The Z Benefit Package for Breast Cancer saw a 1,300 percent increase from PHP100,000 to up to PHP1.4 million. Additionally, the package for neonatal sepsis increased from PHP11,700 to PHP25,793, and bronchial asthma from PHP9,000 to PHP22,488,’ he said.
This includes expanding the hemodialysis package from 90 to 156 sessions, effectively covering the required treatment for Chronic Kidney Disease Stage 5 (CKD5) patients for a year, he ad
ded.
‘In July, we increased coverage per session by 54 percent, from PHP2,600 to PHP4,000, raising annual support from PHP405,600 to PHP624,000 per patient. We have also more than doubled our coverage for hemorrhagic stroke from PHP38,000 to PHP80,000, ischemic stroke from PHP28,000 to PHP76,000, and high-risk pneumonia from PHP32,000 to PHP90,100,’ he said.
Mental health services have been expanded, offering general and specialty mental health services.
The outpatient benefit package for mental health is now available, with efforts to partner with more providers to increase accessibility, while another round of enhancements for Z benefits was introduced, particularly on colon and rectal cancers, and select orthopedic implants, he added.
Adre said PhilHealth Ilocos Region has an average turn-around time of 13 days for good claims, which is 47 days faster than the mandated 60 days processing of claims.
PhilHealth has also taken steps to support hospitals in accounts reconciliation through the Financial Ma
nagement and Reporting Enhancement Program (FinMaREP), wherein they directly engage with the hospitals in reconciling their respective records of accounts to ensure order and accuracy.
Meanwhile, the agency is testing the use of artificial intelligence (AI) as a means to reduce claims processing and improve reimbursements.
Source: Philippines News agency
