PhilHealth only delayed in COVID-19 claim reimbursements, says official


Posted at Aug 16 2021 11:14 AM

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MANILA – PhilHealth is only delayed in reimbursing hospitals for COVID-19-related claims, which account for 15 percent of all the claims it is processing, an official of the state insurer said Monday. 

“I would also like to explain that COVID claims is around 15% of the total claims that we have accepted, that we have received in our offices. And the delay is mostly in the COVID claims only,” PhilHealth vice president for corporate affairs Shirley Domingo said.

“The rest, we are processing in the given time. We have an average of around 43 [days] turnaround time for good claims,” she said. 

Domingo said some of the delay in reimbursements can be attributed to policy issues that are still being decided on.

“For example, drugs and medicines. Will we pay for drugs and medicines that were being identified? There are still some that are being discussed, for example remdesivir. These are medicines that are, you know some, they use it extensively. But there’s still some issues on this,” she explained.

Domingo also said that the state insurer’s manpower was hit hard by the pandemic.

“A lot of our human resources got sick with COVID and isolated or quarantined and our capacity to process claims was also affected,” she said. 

Domingo said the state insurer is augmenting its workforce in their claims processing unit to address this problem.

The Philippine Hospital Association earlier said PhilHealth owed private and public medical facilities some P20 billion in COVID-19 claims.

"Malaki ang epekto 'yan kasi siyempre ang private hospitals, nagre-rely lang sa aming services, admission namin sa aming mga pasyente," Dr. Jose Rene De Grano, president of the Private Hospitals Association of the Philippines Inc., had said.

(It will have a big impact because our services rely only on the admission of patients.)

"Pagka nawalan na nga ng pondo, siyempre maapektuhan po 'yung pangsuweldo, pambili ng supplies, pambayad sa oxygen," he added.

(When there's no funds, it will affect the salary of our employees], our capacity to buy supplies and pay for oxygen.)

The Philippines, as of Sunday, has 102,748 active COVID-19 cases, of which, 0.8 percent are in critical condition, 1.3 percent are severe, and 0.93 percent are moderately ill.

Intensive care unit (ICU) beds allotted for COVID-19 patients all over the country is 70 percent utilized; 60 percent for isolation beds; and, 61 percent for ward beds. Ventilator are 51 percent used up.


--ANC, 16 August 2021