Private hospitals’ group calls out slow reimbursement process at PhilHealth

Sherrie Ann Torres, ABS-CBN News

Posted at Apr 20 2021 05:41 AM

Hospitals fear bankruptcy, potential closure of some facilities

MANILA—Private hospitals are demanding that the Philippine Health Insurance Corp. reimburse them for costs they incurred related with treating patients afflicted with COVID-19. 

Dr. Jose de Grano, president of the Private Hospitals Association of the Philippines (PHAPI), told ABS-CBN News on Monday that the amount of reimbursement applications with the state insurer has reached between P26 billion and P28 billion, as of December 2020.

According to De Grano, this is just an “extrapolation” from their 114 hospital-members that submitted their claims, excluding private health institutions outside Metro Manila. 

PHAPI has 700 member-hospitals nationwide.

President Rodrigo Duterte earlier ordered PhilHealth to speed up reimbursing claims, after its unsettled debt allegedly affected the operations of facilities battling the COVID-19 pandemic.

Asked if Duterte's directive for immediate release of hospital reimbursement claims helped, De Grano said it did not.

“Totoo ba na magre-release talaga sila (PhilHealth)? And how fast sila magre-release? Kasi kailangan na talaga ng mga hospitals itong claims reimbursement na to,” he said.

Philhealth reportedly released a circular following the President’s directive to immediately reimburse the application of private hospitals.

But, since the state of insurer's records are often inconsistent with hospital data, this only slowed down the release of reimbursement, De Grano said.

“Halimbawa, meron kaming supposedly in process na mga claims. Let’s say, sabihin na natin na P20 million. And then sasabihin namin na, ‘O eto ang na-extract namin.' Sasabihin naman ng region, 'Well iba yung na-extract niyo kesa sa aming data.' So du'n nagkakaroon ng problem,” he explained.

If the hospital will agree on the amount presented by the PhilHealth regional office, only then will 60 percent of their claims be released, which based on PHAPI's assessment, would take at least two weeks.

“Imagine ang difference nun (amount), ha? Alin ang tama dun? 'Yung kinukuha namin na data, it came also from their portal ng PhilHealth, hindi ito sa amin. And then sasabihin [nila], 'We don’t have that amount.' Papano na 'yan?” De Grano said.

Philhealth has no guidelines, too, on releasing the remaining 40 percent claim of private hospitals, De Grano said.

“I think ang sinasabi nila diyan is, 'We will hold everything, all your claims until the 60 percent has been liquidated. And then we will go again to the 40 percent.' Another agreement siguro, or another undertaking,” he said.

The PHAPI president stressed the lingering hospital reimbursement issue has a large impact on private hospital operations. Besides the need to shell out their own funds to continuously procure medicines and acquire ventilators for their COVID-19 patients, there are also health workers and other staff that need to be paid by hospitals, De Grano said.

“For the past year, ang mga private hospitals, even government hospitals, have been taking these COVID patients for the past year. Halos wala silang nabayaran dun sa COVID cases na 'yun. And imagine the amount of money na na-spend na ng mga hospitals diyan sa COVID patients na yan,” he said.

Private hospitals are in a quandary as the delayed release of the reimbursements, exacerbated by the COVID-19 spread, has already resulted in the reduction of bed capacities and hospital staff of some health facilities.

“At pag nagpatuloy ito, ang mangyayari diyan . . . baka mag-stop ang operations ng ibang hospitals o i-downsize talaga ang number of beds or some parts of the hospitals just so that we can continue with our operations with minimum expenses,” De Grano said.

“Lalong maaapektuhan (ang health care system). Kaya pinagpapasalamat naming sana kung talagang totoong serious ang PhilHealth on this and they will release at once, this promised amount. Malaking tulong sa mga hospitals,” he added.

PhilHealth last week acknowledged some "slowness" in reimbursing hospitals. The insurer's president and CEO, Dante Gierran, attributed this to coronavirus infections, which he said hit some PhilHealth personnel, reduced its workforce, and prompted a lockdown of its office. 

PhilHealth last year received P107 billion in claims for the service of hospitals to its members, and settled about 85 percent of this, Gierran said. 

"We really have debt, we have debt to hospitals, private or government," he said.

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