Many hospitals, including those in Metro Manila, will sever ties with state insurer, Philhealth over non-payment of their COVID-19 refund claims since 2020, which has reached P834 million. The Private Hospitals Association of the Philippines will submit its position paper next month (November) whether they would stay or leave Philhealth.
SWARMED with hospital claims for refunds due to COVID-19, the state insurer, Philippine Health Insurance Corp. admitted its backlogs but said it is doing everything to speed up the processing of claims.
“We are so swarmed with increase of claims. Can you just imagine, in 2020, we have an average of daily claims of 31,000, and the average number of claims now is 39,000. Ibig sabihin (Which means) that is job increase of 26 percent," said PhilHealth chief Dante Gierran, who last year replaced beleaguered chief Ricardo Morales who later resigned over health reasons.
Gierran, an accountant-lawyer and a former chief of the National Bureau of Investigation, was appointed by President Duterte to Philhealth on August 31, 2020.
PhilHealth oversees the country’s national health insurance program that aims to provide “affordable, acceptable, available, and accessible” health care services for Filipinos.
It subsidizes in part or in full medical expenses of its members in time of need. This is especially critical during a health crisis like the coronavirus pandemic.
Unpaid claims
This, as a group of private hospitals today warned that some of its members might not renew their accreditation with Philhealth because of unpaid claims for COVID-19 cases from last year.
Dr. Jose Rene De Grano, president of Private Hospitals Association of the Philippines Inc, said several private hospitals, including those in Metro Manila, would release in November a position paper whether or not they were cutting ties with the state insurer if the issue remained unresolved.
"Karamihan po diyan ay siguro hindi na magre-renew ng kanilang PhilHealth by next year dahil po sa narasanan nila na wala pong kongkretong solusyon na ibinibigay ang PhilHealth sa nakaraang mga 2 o 3 buwan," he told TeleRadyo.
He claimed that most COVID -19 claims from 2020 are yet unpaid, amounting to P834 million to hospitals in General Santos, Metro Manila, Iloilo and Northern Luzon.
Fraudulent claims
At a Senate hearing, the state insurer also admitted to delays in processing of claims for COVID-19 cases because they were double-checking every document to avoid cases of fraudulent claims that also rocked the agency a few years back.
Gierran added that PhilHealth was also facing a manpower shortage.
"We blame it again on the pandemic because we have a limited locomotive, some of our people got sick, as matter of fact, some of our people even died. And we cannot tell everybody that we have this problem, but we are doing something about it," Gierran had said.
However, De Grano said those allegedly questionable claims being investigated by PhilHealth should not affect the reimbursement of unpaid dues to other hospitals, which they used for their day-to-day operations.
"Kung talaga meron silang pruweba dito sa mga supposedly na fraudulent claims, then i-file po nila. Pero 'yun nga po, napakaliit pong porsiyento niyan," he said.
"Ang ibig sabihin po namin, kung meron mang ganung ilan na mga cases o claims na sa tingin nila ay hindi maganda, bakit naman po nasasakripisyo 'yung iba, 'yung kalahatan na mga iba pang claims na hindi nila bayaran?"
But Senator Risa Hontiveros who joined Philhealth’s board of directors from November 2014 to October 2015, claimed that the slow processing of claims has been a problem even before Gierran came to Philhealth.
“Atty. Gierran, even before you came in, in fairness inabot ko iyang problema na iyan, so it is not just COVID kasi even bago kayo pumasok andyan na rin iyang problema na iyon, maybe it is just exacerbated by COVID," said Hontiveros.
Tags: #Philhealth, #PrivateHospitalsAssociationofthePhilippines, #health, #COVID19refunds