PhilHealth told to prioritize payment of 'valid claims' from hospitals to sustain operations

ABS-CBN News

Posted at Aug 26 2021 10:47 AM

Philhealth Local office at Mother Ignacia St., Quezon City, June 7, 2019. Mark Demayo, ABS-CBN News/File
Philhealth Local office at Mother Ignacia St., Quezon City, June 7, 2019. Mark Demayo, ABS-CBN News/File

MANILA—A health official on Thursday called on Philippine Health Insurance Corp. to prioritize the payment of "valid claims" of COVID-19 cases from private hospitals, which have threatened to disengage with the state insurer due to its unpaid debts.

"Kasi alam natin 'yung PhilHealth kasi ang nagbibigay talaga ng lifeline sa mga hospitals," Health Undersecretary and treatment czar Leopoldo Vega told Teleradyo.

(Because we know that PhilHealth is the lifeline of hospitals.)

"Sinasabi namin sa PhilHealth kung puwede man lang tingnan ang mga valid claims ng mga hospitals."

(We are telling PhilHealth to at least check the valid claims of hospitals.)

Vega said the reimbursements would sustain the operations of private hospitals, which are suffering revenue losses due to lower patient footfall and non-COVID-19 admissions.

"Sa panahon ngayon COVID, ang hirap talaga magkaroon ng revenues, lalong-lalo na sa mga private and public hospitals kasi sarado na ang non-COVID," he said.

(In this time of COVID, it's hard to earn revenues, especially for private and public hospitals because non-COVID [admissions] are closed.)

Last week, the state insurer issued Circular No. 2021-0013, which suspends payment of claims "subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority” for a period of 120 days.

PhilHealth had said it was strengthening its measures to ensure the rational use of funds by detecting potential fraud or reimbursement abuse through dubious claims.

The Philippine Hospital Association earlier disclosed that PhilHealth owed its members an average of P7 million each.

The state insurer owes hospitals some P13.6 billion in denied claims, with P13 billion to P16 billion in-process claims, and P46 billion Return to Hospital (RTH) claims, said PHA president Dr. Jaime Almora. The group has some 1,100 members.

PhilHealth has denied the claim, saying its unpaid claims only amounted to P12.9 billion.

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