Pay up hospital claims, Poe prods PhilHealth

Published May 25, 2021, 11:26 AM

by Vanne Elaine Terrazola

Senator Grace Poe has asked the Philippine Health Insurance Corporation (PhilHealth) to expedite its payment to public and private hospitals and avoid unnecessary and delaying procedures that affect the operations of healthcare institutions.

Senator Grace Poe (Office of Sen. Grace Poe/MANILA BULLETIN File Photo)

In a statement on Monday, May 24, she said the PhilHealth “must do all to address hospital claims it refuses to pay as well as the so-called ‘return-to-hospital (RTH) claims’ which threaten the viability of these hospitals.”

She cited a Commission on Audit (COA) 2020 report on the Philippine Children’s Medical Center (PCMC), which supposedly stated that the state health insurer denied a total of 1,641 claims from the government-run hospital amounting to P22.98 million as of September 30, 2020, while RTH claims amounted to P11.60 million representing 683 claims.

RTH claims were sent back to hospitals as PhilHealth deems they still “lack certain requirements.”

In 2019, PhilHealth denied 1,595 claims from PCMC amounting to P15.31 million, Poe said.

The senator said the COA report stated that PCMC claims that PhilHealth denied increased by 126 percent from 2019 to end of September, 2020 and the hospital’s loss arising from it amounts to P34.59 million.

The PCMC, on the other hand, explained that it has been judiciously following the guidelines of PhilHealth and blamed the denied and RTH claims on “instantaneous changes in the PhilHealth evaluation of claims without further basis on circulars and policies and some technical glitches in the PhilHealth system.”

Poe also mentioned the National Kidney and Transplant Institute (NKTI), whose 2,387 claims worth P30.31 million were denied by the PhilHealth according to the COA. NKTI’s RTH claims amounted to 15,061 worth P122.81 million.

The COA said that PhilHealth also denied 2,432 claims from the Philippine Heart Center worth P38.92 million and its RTH claims reached 1,475 worth P32.25 million.

Among the reasons for rejecting the claims were “unpaid premium contributions” and violations of PhilHealth circulars such as filing beyond 60 days, confinement was less than 24 hours, and the doctor who treated the patient was not accredited by PhilHealth, state auditors said.

“These are just the claims of three government hospitals. Private hospitals lament the same experience. We are in the middle of a pandemic and it is unconscionable that hospitals are not getting paid for services rendered and medicine or treatments administered. Delayed payments are equally unacceptable,” Poe said.

“It’s been a year since numerous PhilHealth issues and the supposed mafia that exists in the organization resurfaced. Despite the change in leadership, it is unfortunate that we are nowhere near resolving the extent of PhilHealth’s problems,” Poe lamented.

The lawmaker said the PhilHealth is expected to step up its efforts amid the COVID-19 pandemic.

Government hospitals, she said, would have operated at huge deficits if not for government subsidies, she said.

“Hindi tama na hindi binabayaran ang mga ospital at hindi makatarungang pabalik-balikin ang mga tauhan nila na umaasang makakakolekta. Ang mga ospital at mga medical frontliner ang magtatawid sa atin sa pandemyang ito. Dapat bayaran na sila ng PhilHealth (It’s not right hospitals are not reimburse and unjust that their people are made to go back and forth to collect the claims.

“Hospitals and medical frontliners are the ones that will help us out in this pandemic. The PhilHealth should pay them),” Poe stressed.

Earlier, a group of public and private hospitals said their members are forced to dig into their savings or borrow from banks due to the delayed reimbursements from the PhilHealth.