Case Study: PhilCare automates patient support across 1,600 hospitals with Proto

PhilCare leads on AI-enabled health insurance with Proto’s AICX Platform

PhilCare, a major health maintenance organization in the Philippines, faced a challenge as its growing membership led to a high volume of routine patient support inquiries. These queries, handled via hotlines and email, were consuming the capacity of their 10-15 member support agents and causing wait times. To address this, they partnered with Proto to implement its AI chatbot, Phil.

The solution from Proto integrated directly with PhilCare's systems via API, allowing members to instantly get plan details, find accredited providers, check claim status, and even generate letters of authorization through an automated chat interface. This resulted in 66% of inquiries being automated and handled 48,000 chats annually. The AI agent achieved a 7-second average response time, freeing live agents to focus on complex cases and improving member access to critical information 24/7.

PhilCare

Alex Aquino

Chief Technology Officer