By Perfecto T. Raymundo, Jr.
PASIG CITY — The Philippine Health Insurance Corporation (PhilHealth) has issued guidelines on Pterygium Excision with Graft and Ocular Surface Reconstructive Surgeries (OSR).
In a press conference, Walter R. Bacareza, PhilHealth Vice President, Corporate Affairs Department, said that PhilHealth has accomplished many things such as settlement of benefits payments, among others.
Bacareza added that there is now the new guidelines on pterygium, excision with graft and ocular surface reconstructive surgeries (OSR).
Dr. Edwin M. Mercado, PhilHealth President and Chief Executive Officer, said that one of the priorities is the YAKAP which was launched last July from Konsulta package which is hospital-based.
“We ensure that the health services extended to PhilHealth members are of quality with the proper registration and identification of each member,” Mercado said.
Mercado stressed that under the Universal Health Law, PhilHealth members will have the freedom to choose and they will be properly be informed.
He cited the Patient Bill of Rights, especially on chronic disease such that after the patients first encounter, they don’t anymore return for follow-up checkup.
PhilHealth also has an ongoing collaboration with the Philippine Institute of Development Studies.
Mercado propounded that no country in the world has sufficient money for heathcare.
“By end of 2028,” Mercado said, “there will be no balance billing for basic or primary healthcare and the zero balance billing is through the DOH.”
“Ito ang aming hakbang upang tiyakin na ang bawat miyembro ng PhilHealth ay makatatanggap ng pinakamataas na posibleng pamantayan ng pangangalaga sa mata,” Mercado said.
“Kami ay nakikipagtulungan sa mga ekspertong doktor at pinapalakas pa namin ang aming mga sistema ng pagsubaybay upang matagumpay na matupad ang mandato ng PhilHealth na makapaghatid ng benepisyong may kalidad,” he added.
Mercado said that PhilHealth is now collaborating with DepEd on the eye care of students 0-15 years old and specialty cases coverage is under study.
“Not only in pterygium,” Mercado said, “but we are looking at the most number of PhilHealth claims.”
“Before contracting a service provider,” he said, “PhilHealth sees to it that the service providers have the capacity to provide quality standard care.”
“From 60 days,” Mercado said, “the payment of PhilHealth benefit claims is now done in 16 days.”
PhilHealth Circular No. 2025-0021, effective Nov. 15, 2025, is a new policy that sets clear quality standards and clinical guidelines for the treatment of pterygium.
This initiative aims to ease the burden of Filipinos with this condition, reflecting the health agenda of President Ferdinand R. Marcos, Jr.
Dr. Lyvia Mei Lee M. Sta. Maria-Gonzales, Medical Specialist, Standards Monitoring Department, said “Pterygium, most commonly known as ‘pugita sa 7 mata’ is a triangular, fleshy, fibrovascular sheet originating from the conjunctiva and extending to the corneal limbus and beyond.”
PhilHealth Circular No. 2025-0021, effective Nov. 15, 2025, is a new policy that sets clear quality standards and clinical guidelines for the treatment of pterygium.
PhilHealth currently covers pterygium excision with graft for (RVS 65426) and P59,085 for ocular surface reconstruction (RVS 65780, 65781, 65782).
Under the new policy, PhilHealth will implement a maximum claim limit for eye surgeons to help ensure patient safety and proper utilization of benefits.
This initiative aims to ease the burden of Filipinos with this condition, reflecting the health agenda of President Ferdinand R. Marcos, Jr.
This limit does not apply to procedures performed by residents-in-training in accredited government and private health facilities with a Philippine Board of Ophthalmology (PBO)-accredited residency training program, thereby promoting continuous quality training standards.
PhilHealth urged members and heathcare providers to familiarize themselves with PhilHealth Circular No. 2025-0021 to ensure full compliance and proper utilization of benefits.
Dr. Raymond Nelson C. Regalado, Vice President of Philippine Academy of Ophthalmology, said “when Pterygium is operated on, in general, the eye is covered for 8 hours, and the cover may be removed after several weeks.”
Regalado added “P18,000 for pterygium is cheaper compared to P57,000 for ocular surface reconstruction.”
Regalado stressed “no eyedrop can cure either the pterygium or cataract.”
Dr. Hector M. Santos, Jr., President of Philippine Academy of Ophthalmology, and from Philippine Medical Association, said that they are supporting the move of PhilHealth, especially with the new guidelines.
“Universal health is one of the priorities of the Philippine Medical Association, especially with the new guidelines set by PhilHealth, is part of our transparency and development,” Santos said.
“The three pillars of the Philippine Medical Association are to serve with integrity, innovation and collaboration,” he added. ###
