PRC asks PhilHealth for representative to facilitate COVID claims

Published January 7, 2021, 12:56 PM

by Merlina Hernando-Malipot

The Philippines Red Cross (PRC) is urging the Philippine Health Insurance Corp. (PhilHealth) to assign a point person or representative to the PRC to facilitate the validation of claims of members who are tested for COVID-19.

Senator Richard Gordon (Senate of the Philippines / MANILA BULLETIN FILE PHOTO)

PRC Chairman and CEO Sen. Richard Gordon reiterated this call after the State health insurer cited the slow process of verification of claims as the reason for the delay in meeting its obligation to the foremost humanitarian organization in the country.

“We test what they send us, what is the deficiency, in the names? The list comes from Coast Guard and LGUs (local government units), it was cited in the contract that we signed that they should put a focal person there but they never did and when we ask for payment, they come up with so many reasons,” Gordon said.

After its obligations again ballooned to P823 million, of which P687 million is overdue, the PhilHealth asked for the PRC’s understanding for its delayed payment, adding that they have to verify the claims one by one to comply with the accounting rules and regulations of the Commission on Audit in processing claims. It also claimed deficiencies in names of claimants also add to the delay.

Under Section D, No. 4 of the Memorandum of Agreement signed between the PRC and PhilHealth, the State health insurer is obliged to assign a point or contact person or representative for the PRC specifically to coordinate with and address concerns of the PhilHealth; Provided, that such point contact person or representative shall assist PRC in monitoring whether or not those being tested are covered by PhilHealth.

PRC noted that Section D, No. 1 also provides that the PhilHealth “shall provide PRC with a database of all persons with PhilHealth coverage to allow PRC to verify whether such persons are indeed covered for purposes of providing testing thereto.” However, PRC said that it has “yet to receive a database.”

For faster and simplified process, the PRC is required – under the MoA – to submit duly accomplished case investigation forms, and a summary of test results duly certified by PRC’s pathologist as submitted to the DoH and RITM and or attached agencies, as the only accepted proof of testing services.

“We are complying. They are asking for the hard copy (of customer information forms), we gave it to them. We asked for the soft copy, we gave it to them. There is always a reason,” Gordon said. “If we are forced to stop because we cannot afford to defray expenses, it would be more dangerous for the country, especially with the new variant.”