MANILA, Philippines — Representative Wilbert Lee of the Agri party-list said
has highlighted issues with the Philippine Health Insurance Corp. (PhilHealth), following grievances from several patients regarding its purported inability to enforce the Outpatient Emergency Care Benefit (OECB) program, long after it was supposed to take effect.
“We aim to avoid misinformation, particularly concerning healthcare services. It’s crucial we don’t offer misleading promises regarding benefits to our countrymen who have for too long been denied the care they truly merit—particularly since PhilHealth possesses billions in resources meant to serve them,” stated Agri Rep. Wilbert Lee.
Lee penned a letter directed at PhilHealth President and CEO Dr. Edwin Mercado aiming to get clarity on the matter.
In his letter dated March 23, the party-list representative referred to the billing statements of two patients from two different hospitals. Both showed that PhilHealth did not cover any costs related to the emergency room services, indicating that the OECB package was neither respected nor enforced.
“It is unfortunate and intolerable that even after the formal declaration from PhilHealth, this ‘outpatient emergency care service’ remains non-functional and inaccessible to PhilHealth members at numerous—if not all—hospitals nationwide,” Lee stated.
In a communication with SANGGRALOKA on Thursday, PhilHealth affirmed that all members have access to the OECB package at all Level 1 through Level 3 certified hospitals beginning February 14th.
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No separate accreditation
“It also states in PhilHealth Advisory No. 2025-0009… that a distinct accreditation is unnecessary for providing the OECB package since the capacity of healthcare facilities for this benefit was evaluated during their grant of PhilHealth accreditation,” it mentioned.
By February 28, there were 1,816 hospitals and infirmaries across the country that PhilHealth had accredited. These facilities include both government-owned and privately-run institutions.
Philhealth instructed individuals to inform them about certified hospitals failing to offer the OECB package at hotline number (02) 8662-2588; alternative contact numbers include 0998-8572957, 0968-8654670, 0917-1275987, or 0917-1109812.
The OECB bundle encompasses all outpatient services and supplies offered at the emergency department (ED) and associated units within PhilHealth-approved healthcare institutions, covering care administered prior to arriving at or during transit to a medical facility.
The coverage includes patients who did not need to be admitted to the hospital, were released within 24 hours of arriving at the emergency department (ED), or passed away while in the ED.
Included in the OECB bundle of cases are symptoms such as vertigo, loose stools, continuous retching, high blood pressure, non-impact-related hemorrhaging, convulsions, intense head pain, and incidents of sexual violence.