PhilHealth responds to viral post alleging denial of benefits after member's death
The Philippine Health Insurance Corporation is reviewing a viral case involving a widow who claimed her late husband was denied health insurance benefits after he died less than 24 hours after being hospitalized.
The agency issued a statement acknowledging a post regarding a member who passed away while being transferred and assessed at a receiving hospital. However, it did not name the PhilHealth member in question.
"We empathize deeply with the family who lost a loved one," the government agency said.
They noted that upon learning of the incident, they "immediately mobilized to understand and address the situation."
"We have since reached out to the member's wife and have agreed on the next steps as we explore all avenues of support," they said.
They continued, "We are likewise coordinating with the hospitals to understand the circumstances of the situation, as part of our sustained efforts to improve PhilHealth's responsiveness. Please know that PhilHealth will always stand with our members, especially in their time of need."
The issue appeared to stem from a now-viral Facebook post on June 12 by Maria Lourdes Sulit, who shared that her husband, Marvin, died from a brain hematoma on June 4.
"We were told that the surgery would cost around P4 million at Manila Doctors Hospital. We were then advised by his attending neurosurgeon that if we don't have that amount, we can transfer Marvin to UERM Medical Center to reduce the cost by almost P2 million. Desperate to save him, I agreed to that option," she recounted.
"However, before UERM could admit him, we were informed that a P1 million deposit was required. With time running out and no way to raise that amount immediately, we had no choice but to wait for Marvin to die. It was heartbreaking and devastating," she added.
According to Sulit, Marvin was admitted at around 5:59 a.m. on June 3 and passed away at 12:29 a.m. on June 4. When she was settling the hospital bill, she was informed that the charges had already reached approximately P200,000.
"I then went to PhilHealth hoping to receive assistance and reduce the burden of the bill. To my shock, I was told that my husband was not eligible for PhilHealth benefits because he had been hospitalized for less than 24 hours," she claimed. "My husband had just died. How could he not be eligible?"
"I was only asking for the benefits that my husband spent more than 25 years contributing to. He was a lifelong member. He paid faithfully throughout his working years," she continued.
When Sulit sought consideration and raised her concerns, she was reportedly told that the policy was based on a PhilHealth circular that had to be followed, or else Manila Doctors Hospital cannot collect from PhilHealth.
"The representative of PhilHealth didn't even sympathize with me or even give comforting words, it was straightforward, all about profits! My husband had died. I was grieving. Yet all I heard were explanations about policies and payments," she alleged.
"What is the purpose of PhilHealth if the people who have contributed for decades cannot access the benefits when they need them most?" she questioned.
PhilHealth has a strict policy requiring a minimum of 24 hours of hospital confinement to be eligible for inpatient benefits, as detailed in PhilHealth Circular No. 31 s.2010.
However, confinement for less than 24 hours is covered if it is an emergency case, the patient is transferred to another facility, or the patient passes away.
