Palace seeks answers over alleged denial of PhilHealth benefits

MALACAÑANG has ordered an investigation into the implementation of state health insurance benefits following allegations that a hospital denied Philippine Health Insurance Corp. (PhilHealth) coverage to a member who died less than 24 hours after admission despite rules allowing benefit claims in such cases.

Palace Press Officer Clarissa A. Castro on Tuesday said President Ferdinand R. Marcos, Jr. wants authorities to determine whether there were lapses in the implementation of PhilHealth policies after a social media post alleged that a 25-year contributor was denied benefit deductions after suffering a fatal stroke.

Under PhilHealth Circular No. 2025-0020, outpatient emergency services and short-term emergency cases that result in death remain covered even if a patient dies within 24 hours of hospital care.

Ms. Castro said any misrepresentation of PhilHealth rules by hospital or billing personnel should be investigated.

“Outpatient services are covered by PhilHealth, so if there were people who failed to properly explain PhilHealth’s coverage, that must be investigated,” she said in Filipino during a livestreamed briefing from Russia.

“In this kind of situation, a thorough investigation is absolutely necessary,” she added.

Ms. Castro said inaccurate information about insurance coverage could impose an unnecessary financial burden on families dealing with medical emergencies.

In a social media post, Maria Lourdes Sulit said her husband Marvin died from a brain hematoma after the family was unable to raise a P1-million deposit for a surgery that was quoted at P4 million.

She said the family was left with a hospital bill of about P200,000 after less than 19 hours of confinement and was informed that PhilHealth benefits could not be applied.

PhilHealth said on Sunday that it had reached out to the member’s family and was coordinating with the hospitals involved to determine the circumstances surrounding the case.

“We will look into it,” Ms. Castro said. “We do not know yet who is at fault here, but a proper and rigorous investigation has been ordered because this must not happen again if it is true that PhilHealth staff committed an error.” — Erika Mae P. Sinaking