Private hospitals blast 'upcasing' claims: Tests will prove COVID infections

ABS-CBN News

Posted at Aug 25 2021 12:12 PM | Updated as of Aug 25 2021 12:28 PM

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MANILA - State insurer PhilHealth should not deepen the "mistrust" with the private hospitals and pay its much delayed dues, the president of the Private Hospitals Association of the Philippines, Inc (PHAPi) said Wednesday.

"Do not increase the mistrust that is right now lumalabas (that is coming out right now). We are seeing some things like a post by PhilHealth regarding 'upcasing' and they are blaming doctors, hospitals," Dr. Jose Rene De Grano told ANC's Headstart.

PhilHealth is said to be investigating cases of "upcasing" or the declaration of minor respiratory symptoms as COVID-19 to claim higher benefits.

"They are trying to show that hospitals are doing this, all hospitals are doing this. That’s something na goes against the trust and supposed to be the partnership between PhilHealth and our health care providers," said De Grano.

He said it would be "really hard to do that without giving good certification" because the RT-PCR tests, which detect COVID-19 infection, are done in laboratories that are accredited by the Department of Health.

Private hospitals have been complaining of long delays in PhilHealth's payment of COVID-19 claims, with De Grano noting that there were even some from 2020. He said the state insurer usually tags these claims as "under investigation" or "under process."

This delay beyond the 60-day period has prompted PHAPi's members to doubt whether PhilHealth actually has the money to pay them, said De Grano. He said 2 member-hospitals have already closed because of mounting losses, and some are "trying to hold on" by downsizing and borrowing funds from banks.

But if the state insurer continues its non-payment, he said private hospitals would have to push through with its plan to "disengage" from PhilHealth.

"If they do not pay, then we’ll have to rethink on that. We’ll have to push on the disengagement process, which will probably commence in October until the end of December. We’ll see how many hospitals will disengage and not renew their accreditation," he said.

Hospitals disengaging from PhilHealth would mean patients would have to shell out the full amount in their bills and seek reimbursement from PhilHealth offices by themselves.

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