As hospital bills mount, Filipinos crowdsource help online for guarantee letters

When hospital bills pile up and settling the balance becomes nearly impossible, many Filipinos turn to Facebook groups for help, seeking guidance from strangers online on the confusing process of guarantee letters.

Guarantee letters or GLs are documents issued by government offices or public officials that promise a certain amount to cover medical expenses while patients wait for formal healthcare assistance. 

On the ground, many face difficulty requesting such letters, citing delayed responses, repeated visits, long queues, and having to almost plead with politicians for urgent help.

Mixed results

Lhyreen Barquilla, a 34-year-old housewife, is the administrator of one community-led Facebook page dedicated to netizens seeking medical assistance. 

She started handling the page, titled “GUARANTEE LETTER/ MEDICAL ASSISTANCE GROUP PHILIPPINES,” following her own experience securing guarantee letters for her mother, who had heart failure. 

“I only decided to manage the page because my mother was also hospitalized last year before she passed away,” she said, citing how she began to understand guarantee letters and their processes.

During her mother’s final hospitalization, Barquilla gathered multiple letters to help cover the bills.

She collected a total of P170,000 in medical assistance from a mix of sources, including a senator, a congressman, the Department of Health (DOH), the Department of Social Welfare and Development (DSWD), and the Philippine Charity Sweepstakes Office (PCSO). 

Her mother’s hospital bill totaled more than P400,000.

“I didn’t really have a hard time,” she said of her experience acquiring the letters. “Yes, it really was a big help.”

But Barquilla’s journey is an exception to the norm. For others, the process is much more complicated and challenging.

Methy Alemania is a 34-year-old mother of a three-year-old child with patent ductus arteriosus (PDA), a congenital heart defect. For months, she went from one office to another, lining up daily with requirements in hand in hopes of getting guarantee letters for her child’s operation.

“You need to have a lot of patience every day,” she said.

In search of direction, Alemania joined online communities such as Barquilla’s. Each visit to a new office also brought new tips from other people running the same tedious but desperately needed errand.

“It’s difficult to ask for help, but it’s even more difficult if you don’t find a way,” she said.

In the instances that she got lucky, Alemania posted about them on the page, hoping it could help other group members with ailing loved ones. 

Guarantee letters for what?

In his 2025 State of the Nation Address, President Ferdinand Marcos Jr. touted the government’s zero balance billing program at DOH hospitals. 

The DOH has guaranteed that patients staying in charity wards will not be charged for services. Health Secretary Ted Herbosa has also said patients no longer need to solicit assistance from politicians to ensure they will not be billed.

The reality on the ground is much more nuanced. The policy risks straining already limited capacity in DOH hospitals, as even some middle-income families opt for admission to minimize costs. 

With only 87 DOH hospitals across the Philippines, distressed patients in need of faster care are left with no choice but to seek treatment in hospitals operated by local government units, state universities, or private entities. The government’s zero-balance billing program does not cover these facilities.

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Knocking on everyone’s doors

Marie*, a mother who asked to remain anonymous, was so desperate that she had her child with a brain tumor admitted to a private room in a DOH hospital. 

Her family’s bill is expected to reach P500,000, including professional fees, part of which must be paid in cash.

“It’s difficult to get GLs…this is what I usually receive,” Marie told Rappler, sending this newsroom a screenshot of a rejection letter from a government office. 

“Almost all senators gave me the same response, even the Office of the President. It’s so hard to ask,” she added. 

Marie also went to a Malasakit Center twice and was told to prepare a promissory note, a final bill abstract, her child’s birth certificate, and a valid ID. At the DSWD, she was offered cash assistance but referred to another office for a guarantee letter. 

All the while, she has to find a guardian to look after her child when she’s away.

“I’m the only one taking care of my child, so I still have to ask others to handle things for me so I can run around and process these requirements,” Marie said.

“We always participate in community service activities and blood donations, but when we need help, we don’t get even a single GL,” she added. 

Patronage politics

For 2026, the Philippine government approved a P51.6-billion fund for the Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP), up from P41.1 billion the previous year.

Some senators argue that the program, which is reliant on politicians’ guarantee letters, enables patronage politics, while House lawmakers maintain it fills critical gaps left by insufficient coverage from state health insurer PhilHealth.

For groups like the People’s Budget Coalition (PBC), the headache caused by the bureaucratic maze of securing guarantee letters is proof that the current system needs fixing. 

“Guarantee letters in their current form risk turning access to care into a political favor rather than a right. The core issue is not only the instrument itself, but its discretionary and non-transparent administration,” PBC said in a statement sent to Rappler. 

To address this, the coalition outlined recommendations for the short to medium term:

1. Institutionalize standardized, rules-based, rights-based eligibility systems with clear implementing guidelines and a prohibition of political intervention in selecting beneficiaries.
2. Publish auditable, regularly updated beneficiary data for major assistance programs such as AKAP, MAIFIP, AICS, TUPAD, and Tulong Dunong, in machine-readable formats, and conduct periodic independent audits of approvals, denials, and geographic distribution.
3. Establish clear, publicly disclosed eligibility criteria, standardized requirements, and defined processing timelines across all agencies implementing medical and social assistance to prevent discretionary interpretation across regions.
4. Shift frontline processing of medical assistance to hospitals and medical social workers, removing approval authority from political offices while still allowing them to support information dissemination and logistics, especially in underserved areas.
5. Create centralized and accessible application systems, including public dashboards, to allow patients to track requests and enable real-time public monitoring of fund allocation and utilization.

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In an ideal world

The Facebook group that Barquilla manages has 29,000 members, and remains active with posts averaging 90 per day. 

The posts share a common theme — query on where to go next, rant on the office that turned down their request, and in moments of victory, testimonial on breakthroughs. 

There are also bigger Facebook communities. One named “Medical Assistance Group – Philippines” boasts a membership of 357,000 users. A quick scan of the group indicates that members also use the page for queries on guarantee letters.

But if they only have a say, families would rather not go through an excruciating process of solicitation. 

“If assistance went directly to the hospital billing or became accessible in our local municipality without too many requirements, it would reduce our stress. In our family’s situation, time is most precious, so any way to speed up the release of aid would be deeply appreciated,” Marie told Rappler. 

“There is already funding in each hospital, right? Why do they still need patients to struggle?” Alemania also asked. 

For civil society, their proposed reforms ensure that health care reaches people because of their right to universal health care.

“Healthcare, social welfare, and other government services must reach people with dignity, on the basis of need, and not political connections,” the People’s Budget Coalition said. “Public service cannot be reduced to a system of favors.” – Rappler.com 

Jia Erikah Fajardo is a journalism student at Colegio de San Juan de Letran-Manila and the features editor of its official student publication The LANCE. She is currently a Rappler intern.