PhilHealth manually process their members’ transactions at the NCR Central Branch in Quezon City on Tuesday, September 28, 2023 following the shutdown of their online system due to a cyberattack last week. Maria Tan, ABS-CBN News/File

MANILA —  The new president and CEO of embattled Philippine Health Insurance Corporation (PhilHealth) on Friday vowed to address the issues hounding the state-owned insurer as stakeholders continue to complain about their performance.

Dr. Edwin Mercado is new PhilHealth chief

Dr. Edwin Mercado, a US-trained orthopedic surgeon with 35 years of experience in hospital management, was named PhilHealth chief last week, replacing Emmanuel Ledesma, Jr.

In an interview with Teleradyo Serbisyo, Mercado said a board meeting will be held later Friday after their mass to celebrate their 30th anniversary.

PhilHealth says planned spending for 30th anniversary ‘reasonable’, within guidelines

"Magkaka-board meeting kami pagkatapos ng aming anniversary mass today so tuloy-tuloy ang trabaho, so babalangkasin po namin sa board yung ganyang usapan at hopefully may ma-announce na kami pagkatapos non," he said.

Among the topics to be discussed by the board was the denied and returned reimbursement claims of hospitals. 

COA urges DOH to resolve P1.3 billion worth of hospital claims denied, returned by PhilHealth

"Ang maipapangako ko yung mga denied claims o return to hospital, sinasabi nyo nga nung COVID pa, ay talaga pong tututukan at meron na po kaming panukala na tatalakayin ngayong hapon," Mercado said, without providing a timeline.

The Commission on Audit's 2023 annual audit report showed government hospitals had claims worth P595,563,644.12 which were denied for reimbursement by PhilHealth. Another P733,460,070.67 were classified as RTH or returned to hospital due to non-compliance with provisions of Republic Act No. 7875 or the law creating the state-run health insurer.

PhilHealth to use nearly P30-B ‘excess’ funds for additional benefits – exec

The COA has directed the DOH to facilitate the collection of the payments from PhilHealth.

Mercado said his leadership will also focus on digitalization in order to fast track processes within the agency. 

"Isa rin po sa nangyayari ay nabubulunan yung sistema, kaya yung digitalization o pagtataas ng antas ng ating information technology ay aking tinututukan na rin para mabilis yung processing at mabilis din na mailabas yung benepisyo," he said.

New PhilHealth chief vows to heal agency from inefficiency, wastage

Meanwhile, the new PhilHealth chief said calls to slash the amount of member contribution will have to be decided by Congress. 

"May mga nakalatag na proposal. Ito ay tinatalakay na sa mababa at mataas na kapulungan at kung anuman ang mapag-desisyunan ng ating mambabatas ay ating susundin," he said.

However, he cautioned that such decision must be based on actuarial study to make sure that PhilHealth will be able to sustain its operation in the future.

PhilHealth was stripped of government subsidy this 2025 as lawmakers argued that they should first exhaust their multi-billion peso unspent or reserve funds. 

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