New speed test for PhilHealth: quicker reimbursement for COVID-19 testing — Recto

Published August 13, 2020, 4:28 PM

by Vanne Elaine Terrazola

Senate President Pro Tempore Ralph Recto on Thursday dared the Philippine Health Insurance Corporation (PhilHealth) to release its reimbursements for COVID-19 tests as fast as its advanced payments to dialysis clinics amid the pandemic.

Senator Ralph Recto
(Senate of the Philippines / FILE PHOTO / MANILA BULLETIN)

Recto said this is the “new speed test” for PhilHealth to debunk claims that it is favoring select health care institutions (HCIs) over government hospitals that are serving and conducting tests for coronavirus patients.

Looking at data on the payments made by PhilHealth for COVID-19 tests and total tests conducted nationwide, Recto said the state insurer’s disbursements were a “mere drop” compared to its reported releases to HCIs under its Interim Reimbursement Mechanism (IRM).

“As of August 10, total payouts of PhilHealth for COVID tests was P380 million. It is a mere drop in the billions of pesos that we’ve been hearing that PhilHealth had spent or keeps in reserve,” Recto said.

“If PhilHealth can give cash advance to dialysis clinics, how come this scheme does not seem to work on a procedure that is vital in fighting this virus?” he added.

Department of Health (DOH) data as of August 11 says 1,853,618 RT-PCR tests have been conducted among 1,733,843 individuals.

“Based on this, wala pa sigurong 10 percent ang na-reimburse ng PhilHealth,” Recto noted.

Recto cited complaints from mayors and hospitals in Southern Tagalog that PhilHealth’s reimbursements for testing were delayed. It was reported that in the province of Cavite, the agency has yet to pay the Ospital ng Imus some P25 million to P30 million for the RT-PCR tests of PhilHealth members. 

The PhilHealth’s reimbursement rates for coronavirus testing are as follows: P3,409 if all the services for testing came from the testing laboratory; P2,077 if test kits are donated; and P901 if test kits are donated, and cost of running the RT-PCR machine is included in the budget of the government facility.

Lawmakers had questioned the PhilHealth’s “inequitable” implementation of the IRM, a program which grants “special privileges” to HCIs that were affected by fortuitous events.

Among others, they learned that the agency quickly gave millions of advanced payments to a dialysis center in days while, on the other hand, reimbursements to COVID-19 referral hospitals have been deferred or limited.

During the Senate hearing Tuesday, the PhilHealth said it issued P14.97 billion in IRM releases to over 700 hospitals nationwide, but the COA said that of the amount, only P1 billion has been liquidated.

Officials of the state insurer denied claims of favoritism and irregularities in its IRM.

“’Yan ang sinasabi ko (That is what I have been saying). IRM as a policy is good. Nasa implementation ‘yan (But the problem is in the implementation). Hindi pwedeng prepaid ang iba, pero ang postpaid na marami ay naghihintay ng matagal ng bayad (You cannot offer some prepaid services and postpaid for the several others for those who have long been waiting for their claims),” Recto said. 

The Senate leader said the PhilHealth and DOH should jointly do a “diagnostics” to remedy the problem.

He said the PhilHealth must also “vet and conduct due diligence in the wake of fraud reports.” 

“But it must do this expeditiously,” he stressed.