State health insurer urges hospitals not to push through with 'PhilHealth holiday'

Mico Abarro, ABS-CBN News

Posted at Dec 28 2021 03:39 PM | Updated as of Dec 29 2021 03:02 PM

MANILA - The country's state health insurer urged hospitals on Tuesday not to push through with a proposed five-day "PhilHealth holiday". 

PhilHealth spokesperson Dr. Shirley Domingo said in a government public briefing that the agency was continuously paying hospital claims, and it was meeting with other hospitals to reconcile unpaid claims. 

"Sana ma-rethink nila itong call na ito kase in the end, yung magsu-suffer din nito ay yung ating mga members," she said.

(We hope they will rethink this call because in the end, it's our members who will suffer.) 

The Private Hospitals Association of the Philippines said on Monday that it was encouraging its members to not accept PhilHealth deductions for their services on Jan. 1-5, 2022. 

This would result in PhilHealth members having to directly ask the agency to reimburse them for their expenses instead. 

"It will be more difficult for PhilHealth and the members din actually," Domingo said. "Kailangan maglabas ng pera itong mga members na ito. And paano nalang yung walang mailalabas na pera at kailangan ng ospital?"

(Members will still have to put out money. So what about those who can't shell out any money but will still need to visit a hospital?) 

According to Domingo, PhilHealth already met with PHAPI and its president Dr. Rene De Grano, while PhilHealth President and CEO Dante Gierran met with hospitals in Iloilo. 

"Sa Region 6, mayroon silang napag-usapan na itutuloy yung meeting to reconcile the figures. Natanggap lang po namin recently yung figures. So we're hoping na makapag-usap pa ulit yung president namin sa mga hospital sa Iloilo." 

(In Region 6, they have agreed to hold more meetings to reconcile the figures. We just got the figures recently, so we're hoping that our president will be able to talk again with these hospitals in Iloilo.) 

Domingo said since January 2020, PhilHealth has paid hospitals some P165 billion in claims. It is also fast-tracking payments of claims via the Debit-Credit Payment Method or DCPM, which has PhilHealth pay 80 percent of a certain claim to a hospital even as it remains on process. 

The PhilHealth spokesperson said that discrepancies in the total cost of claims by some hospitals had to be reconciled first. She explained that PhilHealth was being asked to pay for both denied and returned claims, even though the agency was not supposed to do so. Return-to-Hospital claims were also submitted to PhilHealth that lacked required documentation. 

"Ang return-to-hospital (claim) ay hindi na po payable yan unless i-refile nila yan sa amin," she said. "And yung denied, iba naman proseso nun. Pwede pong i-appeal yung denied na yun. But habang hindi pa settled yung denied claim na yun, hindi namin payable yun kase denied na nga eh."

(Return-to-hospital claims are not payable unless the hospital refiles it with us. As for denied claims, it is a different process but they can appeal them with us. But as long as they are not settled, those claims are not payable because they were denied.) 

Good claims, meanwhile, will be paid within 60 days of processing. 

In case some hospitals still pushed through with observing the five-day PhilHealth holiday, Domingo said PhilHealth members should seek out other hospitals who haven't broken ties with the agency to avail of the deductions.

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