PhilHealth official: Around 80% of hospital claims already settled

Published June 19, 2021, 2:01 PM

by Jhon Aldrin Casinas

The Philippine Health Insurance Corporation (PhilHealth) has already reimbursed nearly 80 percent or about P231 billion of the total hospital claims, an official said Saturday, June 19.


Dr. Shirley B. Domingo, PhilHealth’s vice president for Corporate Affairs and spokesperson, said the total amount of hospital claims submitted to the state insurer was about P259 billion.

The amount, she explained, includes the claims of both patients with coronavirus disease (COVID-19) and non-COVID patients.

“Doon sa total claims, whether COVID or non-COVID, nakapagbayad na tayo ng mga 79 percent of the total claims na binigay sa atin (For the total claims, whether COVID or non-COVID, we have already paid about 79 percent of the total claims given to us). That’s around P231 [billion],” Domingo said in a public briefing.

“‘Yung total amount kasi na sinubmit sa atin is around P259 billion. So, 79.6 percent as of now ang nabayaran na natin (The total amount submitted to us is around P259 billion. So, we have already paid 79.6 percent as of now),” she added.

However, she did not mention which periods are covered by the claims.

Meanwhile, the PhilHealth official said the agency has released around P6.3 billion for hospital claims under its Debit-Credit Payment Method (DCPM).

She said that 206 healthcare institutions have availed of such payment scheme.

“Under the DCPM ay nakapaglabas na tayo ng mga P6.3 billion, and around 206 healthcare institutions ang nag avail (Under the DCPM, we have released about P6.3 billion, and around 206 healthcare institutions have availed),” Domingo said.

The DCPM was created to facilitate the settlements of claims to be paid to healthcare facilities to ensure the continuous delivery of health services during the pandemic.

The PhilHealth assured the public that the agency has enough funds to cover the hospital expenses of its members in this time of pandemic.

“May sapat tayong pondo this year (We have enough funds for this year). We are in constant discussions with our financial managers,” Domingo said.

“So right now, may pera pa naman para magbayad ng benefits natin (we still have the funds to pay for our benefits),” she added.