Private hospitals’ group seeks dialogue with DOH, PhilHealth over slow claims reimbursement

ABS-CBN News

Posted at Apr 22 2021 01:42 PM | Updated as of Apr 22 2021 01:51 PM

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MANILA - Private hospitals are no longer able to expand their capabilities due to the delay in hundreds of millions in reimbursements from the Philippine Health Insurance Corporation, the head of a hospital association said Thursday. 

Dr. Jaime Almora, president of the Philippine Hospital Association said PhilHealth’s unpaid claims reimbursements to private hospitals run from hundreds of millions to a billion.

“Sumasagad na losses nila dahil hindi pa sila binabayaran ng PhilHealth, malaki na, hundreds of mlllions yung malalaking hospitals natin kaya nagrerefuse na talaga sila dahil hindi na sila sigurado kung mababayaran pa. Finance ang pinakamalaki (problem) dahil ang mga COVID cases hindi pa binabayaran ng PhilHealth at instead, mga denials at return to hospitals ang mga claim kaya medyo parang languishing yung mga private hospitals natin,” Almora said in an interview on TeleRadyo. 

Almora said 60 percent of the healthcare is provided by private hospitals while 40 percent are government hospitals.

“Ganun karami ang private hospitals kaysa sa government kaya significant yung role ng private hospitals. But both government and private hindi babayaran yung mga reimbursement nila,” he lamented.

He added that private hospitals were not satisfied with the circular issued by PhilHealth.

“Nagkaroon kami ng dialogue, pero yung ginawang circular hindi kontento, lalo silang natakot yung mga private hospitals kasi they have to sign an undertaken, yung claims nila aaplayan nila at popirma ng undertaking na pwede magbigay sila ng additional problems sa mga managers ng hospitals kaya natakot silang pumirma kaya ganun nga ang nangyari merong problema,” he said.

Almora said they hope to set up another dialogue with the PhilHealth, the Department of Health, PHA and the Private Hospitals Association of the Philippines (PHAPI) to “thresh out” the problem.

“Kailangang i-synchronize din ng DOH at saka PhilHealth yung kanilang mga administrative orders at mga circulars dahil meron hindi pagkatugma-tugma ng mga ginagawa nila. May mga orders ang DOH na hindi naman applicable, hindi pwedeng gawin dahil yung PhilHealth hindi naman synchronize doon sa ginagawang claims reimbursement ng PhilHealth,” he said.

President Rodrigo Duterte earlier ordered PhilHealth to speed up reimbursement claims as unsettled debts continued to cripple private hospitals' operations.