Dialysis claims in Western Visayas reach PHP4.1 billion

Hemodialysis treatment has topped all benefit claims paid by the Philippine Health Insurance Corp. (PhilHealth) in Western Visayas over the past three years, totaling PHP4.12 billion in reimbursements from June 2023 to June 2025.

The surge follows the expansion of PhilHealth’s dialysis coverage from 90 to 156 sessions annually, raising the maximum benefit per patient to PHP990,600.

A total of 814,973 dialysis sessions were reimbursed across Region VI during the period, with 46.92% of claims coming from Negros Occidental and 34.81% from Capiz.

Patients diagnosed with chronic kidney disease (CKD) stage 5 are entitled to PHP6,350 per session, covering drugs, laboratory tests, medical supplies, administrative, and professional fees.

PhilHealth Acting Regional Head Lazaro T. Tabsing urged accredited dialysis facilities to ensure accurate and complete documentation to avoid claim delays or denials.

“PhilHealth processes and pays valid claims within 25 days,” Tabsing said. “However, some claims are returned due to discrepancies or lacking/incomplete documents.”

He warned that claims filed beyond the prescribed period or involving patients not registered in the PhilHealth Dialysis Database (PDD) may also be denied.

Tabsing emphasized the need to invest in prevention and early detection to ease the burden of chronic illness in the region.

“While PhilHealth continues to support patients undergoing hemodialysis, it is equally important to focus on early detection and prevention to reduce the burden of chronic illnesses,” he said.

He encouraged members to maximize the expanded primary care coverage under the PhilHealth Yaman ng Kalusugan Program (YAKAP).

The YAKAP package covers outpatient consultations, health screenings, cancer diagnostic tests, and prescribed medicines through YAKAP-accredited physicians.

To date, 212 health facilities under the YAKAP program are operating across Region VI to make primary care more accessible to local communities.

PhilHealth said it continues to work with health providers and stakeholders to streamline the claims process and promote access to affordable, quality care.