"Buhay ang nakataya rito!" — Bong Go calls out PhilHealth after denial of newborn\'s benefits due to poor information dissemination, lack of proper implementation of policies

A recent social media post highlighted the case of a newborn who was reportedly denied by a hospital of his Philippine Health Insurance Corporation (PhilHealth) benefits due to an alleged misinterpretation of existing policies. This incident has prompted Senator Christopher "Bong" Go to advocate for immediate clarifications and reforms within PhilHealth to prevent similar occurrences in the future.

The situation involved an infant born on February 22 and discharged from the hospital on February 26. Due to unforeseen complications, the child required readmission on the same day. However, the hospital informed the parents that a 24-hour interval was necessary before the newborn could again avail of PhilHealth benefits.

“Nakarating sa akin ang isang viral Facebook post tungkol sa bagong panganak na sanggol na inilabas ng ospital noong February 26. Sa parehong araw, kinailangan ulit siyang isugod sa ospital dahil sa sakit. Ngunit ang sabi ng ospital, hindi na raw siya pwedeng maka-avail ng PhilHealth benefits ulit,” Go cited which appeared as the hospital's erroneous understanding of PhilHealth's existing policies. 

Senator Go stressed the importance of ample and accurate information dissemination to both healthcare providers and the public. He noted that misinterpretations of policies could lead to unjust denial of benefits, especially in critical situations involving vulnerable patients like newborns.

“Nakakagalit naman ang ganitong patakaran. Wala namang pinipiling oras ang sakit lalo na sa bagong silang na sanggol. Buhay ang nakataya rito! Lahat naman ng Pilipino ay miyembro ng PhilHealth at dapat makakuha ng benepisyo ayon sa Universal Health Care Law,” Go stressed. 

He underscored that healthcare policies should prioritize patient welfare and adapt to real-world medical needs.

“Hindi ko lubos maisip paano kayang sikmurain ng PhilHealth o ng ospital na sabihan ang isang magulang na kailangan mong mag-antay ng ilan pang oras bago makakuhang muli ng benepisyong pangkalusugan mula sa gobyerno habang maghihingalo na ang isang sanggol at kayo naman ay lumalangoy sa bilyun-bilyong excess funds na nakatengga lamang!” he said.

Senator Go also noted that beyond policy implementation, there is a pressing need for PhilHealth to enhance its information dissemination strategies. Effective communication ensures that both healthcare providers and patients are well-informed about their rights and the scope of coverage, thereby preventing misunderstandings and ensuring timely access to medical services.

He pointed out that repeated Senate hearings have already pressured PhilHealth to review and revise such policies, yet cases like this persist.

“Bilang Chairperson ng Senate Health Committee, labintatlong beses na tayong nag-hearing ukol sa kalagayan ng ating healthcare system. Kasama na d’yan ang pagtalakay ng mga outdated at anti-poor policies ng PhilHealth tulad ng 24-hour Confinement Rule at Single Period of Confinement Policy na sa ating pangungulit ay naitigil at narepaso na. Ngunit ano na naman ito?” he said.

Since July 2024, Senator Go has publicly opposed the agency's transfer of excess funds to the National Treasury, warning that such actions could negatively impact healthcare services. During a Senate Health Committee hearing, he intensified his criticism, arguing that the fund transfers were “maybe legal but morally unacceptable.”

The Supreme Court issued a temporary restraining order against the fund transfer which is currently being deliberated on in court, reinforcing the concerns Senator Go had raised months earlier.

Senator Go also pointed out PhilHealth’s failure to properly inform the public about their benefits, particularly under its Libreng Konsulta program. The initiative, which is supposed to provide primary care services, laboratory tests, and free medicine, has suffered from poor public awareness.

“Sa PhilHealth, mukhang may pagkukulang pa rin sa inyong information dissemination at proper implementation ng inyong mga polisiya. Kaya hindi tayo titigil sa ating mga pagdinig hanggang maisaayos ng PhilHealth ang ganitong mga patakaran na imbes na makatulong ay nagiging dagdag pasakit sa mga may sakit,” said Senator Go.

Despite its potential benefits, the Konsulta program remains underutilized based on recent reports, with many Filipinos unaware that they can register for free outpatient consultations and preventive care. The senator called on PhilHealth to strengthen its information campaigns so that more members can access their entitlements.

Senator Go has also pushed PhilHealth to accelerate its other long-overdue reforms following the removal of the Single Period of Confinement (SPC) Policy. While its elimination marked a significant step prompted by his consistent appeals for change, he has continued to press for the revision of the 24-hour Confinement Rule. In response to these efforts, PhilHealth officials have expanded emergency care benefits to ensure that outpatients are no longer denied coverage.

In addition, after multiple appeals from Senator Go, PhilHealth has committed to implementing a range of improvements, including increasing case rates, expanding benefits packages for the top ten mortality diseases, providing free medicines and assistive devices such as eyeglasses and wheelchairs, and incorporating dental, visual, emergency, and preventive care into its coverage.

The senator directly appealed to PhilHealth’s leadership to ensure that such cases do not happen again, stressing that the agency’s funds should be used to serve the people and not withheld through bureaucratic inefficiencies.

“Umaapela ako sa pamunuan ng PhilHealth na aksyunan ang ganitong mga problema sa lalong madaling panahon. Repasuhin n’yo ang mga anti-poor policies, itama ang implementasyon ng inyong mga benepisyo, gamitin ang pondo para mapakinabangan ng may sakit, at higit sa lahat, bumaba kayo at tingnan ang tunay na kalagayan sa mga ospital nang sa gayon ay matugunan n’yo ang pangangailangan ng mga Pilipino pagdating sa kalusugan!” he said.

He also reiterated that access to healthcare is a constitutional right and that policies should reflect this principle. “Health is a constitutionally guaranteed right of our people. Health is life. Please, do not gamble with the lives of our people because of your inefficiencies and inadequacies,” Senator Go warned.

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