PhilHealth Forward spotlights innovations, anti-fraud initiatives

THE Philippine Health Insurance Corporation (PhilHealth) today, Aug 6, 2019, will formally unveil its new Expanded Primary Care Benefit (EPCB) and Z-benefit Providers, new out-patient benefits,  Information Technology (IT) breakthroughs and anti-fraud activities.

Dubbed as “Philhealth Forward,” the activity showcases additional ePCB Providers:

• one contracted facility for three catastrophic diseases under the Z-Benefit Package;
• Outpatient Benefit for Secondary Prevention of Rheumatic Fever/RHD;
• Certification of Health Information Technology Provider (HITP);
• Introduction of PhilHealth RIDES (Responsive Information, Dissemination and Education Services);
• Launching of the Text BPN; and
• Anti-fraud steps to deter misuse of PhilHealth fund.

Recently, Philhealth expanded its Primary Care Benefits that can be availed of by all members and their qualified dependents under the formal economy or the employed sector, lifetime members, and senior citizens to cover more illnesses, disabilities and maintenance medicines for members.

The ePCB includes coverage for those who have diabetes, hypertension, acute gastroenteritis, upper respiratory tract infection and pneumonia and those who need maintenance drug.

Initially, PhilHealth has accredited only two EPCB providers – Qualimed Hospital and Sebaste Community Hospital.

“We encourage our members to visit and avail of the ePCB because we have enough accredited facilities that can provide promotive and preventive care to all our members,” said Acting Regional Vice-President for Western Visayas Janet A. Monteverde.

Today, PhilHealth will accredited  more ePCB providers – The Health Centrum Hospital, South Bacolod General Hospital and Medical Center, San Carlos Doctor’s Hospital, Saint Gabriel Medical Center, Metro Iloilo Hospital, Don Jose Monfort Medical Center, Aklan Baptist Hospital, and Holy Mother of Mercy Hospital.

Meanwhile, Western Visayas Medical Center (WVMC) will seal its partnership with PhilHealth today for the management and care of three (3) additional Z-Benefit Packages – Coronary Artery Bypass Graft, Closure of Ventricular Septal Defect and Tetralogy of Fallot.

Under PhilHealth’s Z-Benefit, these packages focus on providing relevant financial risk protection against illnesses perceived to be medically and economically catastrophic.

“We would like to thank WVMC for your long-standing and solid partnership with PhilHealth. Aside from managing and caring for our members diagnosed with Lymphoblastic Leukemia, Prostate Cancer and Breast Cancer,  they have committed to care for more members suffering from heart ailments,”  Monteverde added.

PhilHealth is also introducing the new Outpatient Benefit for Secondary Prevention of Rheumatic Fever (RF/RHD) at the rate of P12,000/year.

RF/RHD is the 4^th leading cause of adolescent mortality in the Philippines.

Meanwhile, to facilitate faster and more efficient claims processing, online submission of claims document was implemented by PhilHealth.  On June 20, 2019, St. Paul’s Hopital took an inch higher as it developed a homegrown system that could facilitate claims submission with PhilHealth.

PhilHealth, on the other hand, intensifies its campaign to help curb fraud in light of the Universal Health Care Law’s enactment.

”We cannot risk our fund to any corrupt individuals for their personal gain. PhilHealth is in close collaboration with our relevant stakeholders and partners to protect our fund,” Monteverde said.

One of the noble activities of PhilHealth’s Satellite Office is the PhilHealth RIDES (Responsive Information Dissemination and Education Service) wherein employees of the Corporation put to good use their biking skills to reach remote areas in the island to orient members on their benefits, update their profile and at the same time enrol new members to PhilHealth.

“Our dedicated men and women use their love for biking to bring PhilHealth closer to our members especially those living in far-flung areas,” Monteverde said.

Furthermore, one of the latest initiatives of PhilHealth 6 is its Text BPN. This is a platform where members can now receive their Benefit Payment Notice through text messaging instead via postal or “snail” mail.

Monteverde said that once the member received the BPN, they could compare this with the statement of account from the hospital if indeed the PhilHealth benefits were accurately deducted from the actual bill. (PRO 6-PAU/L. G. Lira)