PhilHealth says it owes hospitals over P25 billion, plans to settle it in 6 months

RG Cruz, ABS-CBN News

Posted at Jan 11 2022 06:30 PM | Updated as of Jan 11 2022 11:38 PM

MANILA (UPDATE)—The Philippine Health Insurance Corp. (PhilHealth) owes hospitals more than P25 billion, its president and CEO said Tuesday.
Dante Gierran said the company hopes to pay the claims in 6 months, following plans by some hospitals to sever ties with the state insurer over the matter. Such a plan, a so-called "PhilHealth holiday", was suspended December 29.  
“Specific na lang na commitment kung magkano ang babayaran, when, hindi ba pwedeng ganun na lang? Anong target niyong bayaran na amount at kailan?“ Marikina 2nd District Rep. Stella Quimbo asked Gierran at a hearing.

(Can't there be a specific commitment as to how much should be settled and when? What is the target amount to be paid, and when?)
“Itong i-process po namin na P25.45 billion, we have to [pay] this in 6 months’ time,” Gierran answered.

(The P25.45 billion we are processing right now should be paid in 6 months’ time.)
Gierran told lawmakers he ordered all regional conciliation and mediation branches of PhilHealth to coordinate with partner hospitals on the status of claims. 
The state insurer explained that the debit-credit payment method (DCPM) aims to expedite payments. So far, PhilHealth has supposedly paid P12.06 billion to hospitals.

PhilHealth said DCPM "provides hospitals sufficient cash flow to continue providing the sick with quality health care during the pandemic."
Gierran attributed the slow payment of claims to the lack of manpower and information technology caused by the pandemic.

Dr. Jaime Almora of the Philippine Hospitals Association said that the possible departure of hospitals from PhilHealth over unpaid claims meant they would not allow the state-run firm to accumulate payables from the expenses of its members. 
Almora said hospitals would help patients collect reimbursements from PhilHealth. He also believes that it could pay. 

“Wala namang problema sa intensyon ng top management natin. Ang problema ’yung sa regional offices dahil sila ’yung nagbabayad. Sila ’yung maikukulong 'pag dinemanda sila ng NBI or PhilHealth,” said Almora.

(We do not have a problem with the intention of the top management. The problem is in the regional offices because they are the ones paying. They are the ones who could go to jail.)

"More and more hospitals applied for DCPM (Debit-Credit Payment Method). There was improvement in the payment of COVID claims. However there are still hospitals that are skeptical because they cannot understand why we are talking about DCPM when we can talk about normal processing, speeding up the normal claims processing." Almora said.

Gierran said that as of January 7, 2022, the agency has already released P12.05 billion to 444 hospitals via the Debit-Credit Payment Method (DCPM).
The hearing also tackled House Bill No. 7429 or the proposed “Social Health Insurance Crisis Act of 2020” authored by Quimbo.
Quimbo said the bill would empower the President of the Philippines to reorganize PhilHealth to make it more effective. It would create a Joint Executive-Legislative Social Health Insurance Crisis Commission that would pursue PhilHealth’s reorganization.


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Gierran opposed the bill in behalf of his agency, stressing that the reorganization of Philhealth was done under Republic Act 11223 or the “Universal Health Care Act”, which allowed them to outsource some of their functions under Republic Act No. 9184 or the"Government Procurement Reform Act”.
He also rejected the proposed Joint Executive-Legislative Social Health Insurance Crisis Commission because there is already a Joint Congressional Oversight Committee on Universal Health Care tasked to review the agency’s performance.
Quimbo’s bill has been endorsed to a Technical Working Group for further study.