MANILA— “He has to tell us exactly what his issues are.”

Dr. Shirley Domingo, spokesperson of state insurer PhilHealth, had this to say to Private Hospitals Association of the Philippines Inc. (PHAPI) president Dr. Jose Rene de Grano, hours after the latter said their group will push through with a "PhilHealth holiday" either January of February next year.

The PHAPI had earlier said it was encouraging its members to decline PhilHealth deductions for their services on January 1 to 5, 2022, in support of seven Iloilo hospitals who severed ties with the state insurer over P895 million in unpaid claims.

• 7 Iloilo hospitals sever ties with PhilHealth over P895 million in unpaid claims
• Private hospital group pushes for PhilHealth holiday Jan. 1 to 5

The group has since put its planned "PhilHealth Holiday" on hold, citing citizens' and patient groups' request to be "informed well and advised on what to do during the holiday."

• PHAPI hospitals plan for ‘PhilHealth holiday’ suspended

“I hope he (De Grano) tells us exactly what else we have to discuss, para (so) we can sit on the table again, and find out what we can do regarding their issues,” Domingo told ABS-CBN News in a phone interview.

“We would want to listen to him and hear from him kung ano 'yung other issues he’s referring to, para ma-address natin,” she added.

(We would want to listen to him and hear from him what the other issues are, so we can address them.)

Prior to his announcement, De Grano had a meeting with PhilHealth officials regarding concerns of private hospitals, according to Domingo.

During that meeting, she said PhilHealth presented its proposed reforms, which include improving their IT system for the processing of claims, streamlining of proceses, formulating an improved Debit-Credit Payment Mechanism, and increasing the number of personnel attending to hospital claims.

PhilHealth, however, only learned of the suspension of the "PhilHealth Holiday" through the media, said Domingo. De Grano has yet to inform them of their next meeting date, she said.

“After the announcement, we still have to wait for his (De Grano) plans kung ano ang balak nila, because wala pa silang any official word sa amin eh. Even regarding the ‘PhilHealth holiday,’ wala pa siyang official word sa atin,” Domingo said.

[After the announcement, we still have to wait for his (De Grano) plans because they have no official communication with us. Even about the "Philhealth holiday," they have no official word with us.]

Domingo said it was her first time to hear that PHAPI also has its concerns about the state insurer's “Performance Commitment" with private hospitals.

De Grano told ABS-CBN News Wednesday that PhilHealth should also amend its “one-sided” Performance Commitment with private hospitals.

“He has to tell us what’s in the Performance Commitment," Domingo said.

"Hindi niya binanggit 'yan in previous meetings… So it’s best that we sit down and discuss what issues, dun sa table namin, sa meetings namin, before he goes out [to] media para naman ma-discuss namin thoroughly ang issues,” she said.

(He never mentioned that in previous meetings… So it’s best that we sit down and discuss the issues, on the table, during our meetings, before he goes out to media so we can thoroughly discuss the issues.)

PhilHealth’s regional offices are now also in communication with private hospitals, Domingo said.

Meanwhile, PhilHealth continues negotiations with the seven Iloilo-based hospitals and the Far Eastern University–Dr. Nicanor Reyes Medical Foundation (FEU-NRMF) in Quezon City, which already announced their “disengagement” from PhilHealth, said Domingo.

Domingo denied PHAPI’s allegation that some unpaid claims from these hospitals are “decades-old.”

She said, however, that there are claims in their files that are more than two years old.

Claims of more than two years are likely subject to legal issues, among other reasons, Domingo said.

“'Pag legal, medyo matagal 'yun dahil may appeal-appeal, depende sa mga lawyers. And then there’s a whole process of MR (Motion for Reconciliation) 'pag may legal.. a legal case,” she said.

(If the case involves legal issues, that may take a while to be resolved because there are appeals, depending on the lawyers. And there's a whole process of filing a motion for reconsideration in a legal case.)

She also said that PhilHealth incidentally, continues to receive “false claims” from hospitals, explaining why they really need to scrutinize every application.

These include “double-filing of claims,” which happens when the attending filing personnel thought that the initially submitted file failed to enter the PhilHealth e-system, and the “Return-to-Hospital” claims, which have questionable or unclear entries, Domingo noted.

Amid the issues between hospitals and the state health insurer, Domingo assured the public that all Philhealth members can still enjoy their benefits.

Any changes in the situation, she said, will be readily addressed by the agency.

“We will come out with necessary information to our members if ever may ma-confirm na meron nang magdi-disengage…'Pag mangyari 'yun we will be coming out with advisories for our members. Be sure that if ever mangyayari 'yun, we will come out with information for our members to do,” Domingo assured the public.

(We will come out with necessary information to our members if ever it is confirmed that some hospitals will disengage… if that happens we will be coming out with advisories for our members. Be sure that if ever that happens, we will come out with information on what our members should do.)

Domingo said while she sees the point of some senators that PhilHealth should be led by someone who is an expert in “finance, accounting and fund management,” there are still other factors involved in running the agency.

“PhilHealth is not all about funds, it’s also about health and health behavior… Our Board is made up naman of a mix of fund manager experts and health experts. So, that’s a good mix, 'yung Board natin (our board) who [comes] out with policies in PhilHealth,” Domingo pointed out.

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