Senator Christopher “Bong” Go urged the Philippine Health Insurance Corporation (PhilHealth) to ensure that its promised wider coverage and emergency care reforms are actually delivered to members, following a public complaint involving the reported non-coverage of medical expenses after the death of a longtime PhilHealth member.
Go said the incident must be carefully verified based on the full facts, but stressed that PhilHealth must determine whether the patient should have been covered under existing emergency care benefits and whether any lapse in hospital implementation, PhilHealth processing, or public communication prevented the family from availing of assistance.
The concern came after Maria Lourdes Sulit, in a public Facebook post titled “My Life in Two Days,” shared the circumstances surrounding the death of her husband, Marvin, who died on June 4 from a brain hematoma. According to her post, the family was confronted with high hospital costs, including an estimated surgery cost of around P4 million and a P1 million deposit requirement before admission to another facility.
Sulit said her husband died after the family was unable to immediately raise the amount needed for treatment. She also stated that the hospital bill had reached approximately P200,000 in less than 24 hours and that she later sought PhilHealth assistance to help reduce the financial burden.
In the post, she alleged that PhilHealth benefits were not applied to the bill, reportedly because her husband’s confinement lasted less than 24 hours. She also raised questions over the reported denial of a resuscitation package and said her husband urgently needed surgery that was never performed. The allegations remain subject to verification by PhilHealth and the concerned health facilities.
Go said PhilHealth must look into the incident and determine why the family was reportedly unable to avail of benefits, especially since the 24-hour confinement rule had already been addressed and should no longer be used to automatically prevent patients from receiving emergency care benefits.
“Nakikiramay po ako sa pamilya Sulit. Nakakalungkot at nakakabahala po ang kanilang kwento. Mahalagang malaman ang buong katotohanan at ang dahilan kung bakit hindi raw na-cover ng PhilHealth ang kanilang medical bills,” Go said.
Go, a health reforms crusader, said the issue is no longer only whether reforms have been announced, but whether these reforms are being properly enforced, clearly understood by hospitals, and felt by patients during emergencies.
“Kung totoo ngang may lumang polisiya pa ring naipapatupad kahit ipinahinto na ito, hindi po ito katanggap-tanggap. Dapat malinaw sa PhilHealth personnel, sa mga ospital, at sa mga pasyente kung ano ang mga benepisyong dapat nilang matanggap,” he said.
Go said PhilHealth must get to the bottom of the incident and ensure that patients and their families are not left confused or helpless during medical emergencies. The senator’s office already coordinated with PhilHealth for them to check the details of the reported incident and determine what actions may be taken under existing rules.
He said that if a patient is qualified under PhilHealth’s emergency care benefits, the assistance must be applied properly and promptly, instead of leaving families to navigate technical rules at the height of a medical crisis.
“Ang PhilHealth po ay hindi negosyo na dapat mag-ipon lang ng pondo. Ito ay medical insurance para sa lahat upang may masasandalan ang mga Pilipino kapag nagkasakit,” he said.
He added that the agency must continue improving the implementation and communication of its reforms so that members, especially poor and vulnerable patients, can actually feel the benefits in hospitals.
“Kung naghulog ang miyembro at may karapatan siya sa benepisyo, dapat tulungan siya at ang kanyang pamilya sa tamang proseso. Dapat ang PhilHealth, ramdam ng tao lalo na sa oras ng emergency,” Go said.
The reported case comes against the broader context of Go’s repeated calls for reforms in PhilHealth. On July 19, 2024, he began publicly criticizing the management of PhilHealth funds, particularly the transfer of excess funds to the National Treasury, warning that such action could affect health services.
Following Go’s repeated appeals, PhilHealth has moved to implement several reforms to make healthcare more accessible and affordable, particularly for poor and marginalized patients. These include the lifting of the 45-day annual limit on hospitalizations for members and their dependents, allowing continued coverage for prolonged illnesses, including chronic and life-threatening conditions.
PhilHealth has also committed to expanding benefit packages to cover dental services, mental health care, outpatient drug coverage, diagnostic tests such as MRI and CT scans, medical transportation services, assistive devices such as wheelchairs and crutches, chemotherapy for cancer patients, treatment for severe cardiac conditions, and rehabilitation services.
The agency has likewise expanded support under Z Packages for kidney-related illnesses, including peritoneal dialysis, kidney transplantation involving living and deceased donors, and pediatric dialysis coverage. Additional packages have also been developed for ischemic heart disease, covering emergency intervention up to post-surgery rehabilitation.
Go has also pushed for better access to PhilHealth services in hospitals and Malasakit Centers, including the presence of PhilHealth representatives who can assist patients and their families more directly.
After the scrapping of the Single Period of Confinement policy, Go also called attention to the 24-hour confinement rule, which prevented patients from availing of PhilHealth benefits unless confined for at least one day. PhilHealth later repealed the rule for emergency outpatient cases and expanded coverage for emergency services.
Despite these reforms, Go said vigilance remains necessary to ensure that policy changes are properly enforced and understood by hospitals, PhilHealth personnel, and the public.
“Tandaan po natin na ang pondo ng PhilHealth ay pera ng taumbayan. Dapat lamang na ibalik sa kanila ito sa pamamagitan ng maayos na serbisyong medikal,” Go said.
“Hindi sapat na may reporma sa papel. Dapat alam ito ng tao, alam ito ng ospital, at naipapatupad ito nang tama. Ang PhilHealth ay para sa Pilipino, lalo na sa oras ng pangangailangan,” he added.
