Go urges Philhealth, hospitals to cooperate in expediting unpaid claims

Published July 26, 2021, 10:03 AM

by Mario Casayuran

As the COVID-19 pandemic continues to threaten the health and well-being of Filipinos, Sen. Christopher “Bong” Go on Monday Ju6y 26 echoed President Duterte’s urgent request for the Philippine Health Insurance Corporation (PhilHealth) to fast-track the processing of unpaid claims due to various hospitals.

Go, chairman of the Senate Committee on Health, reached out last week to PhilHealth President Dante Gierran and expressed his concern that his office has received numerous complaints of unsettled hospital claims.

Bagama’t overwhelmed ang PhilHealth at apektado rin ang kanilang operasyon dahil sa pandemya, nagbigay ng assurance si Mr. Gierran na ginagawa ng PhilHealth ang lahat para mapabilis ang proseso (While PhilHealth is overwhelmed and their operations were also affected by the pandemic, Mr. Gierran has given an assurance that PhilHealth is doing everything to expedite the process),” Go said.

Halos 12.5 million claimants ang pinoproseso nila sa isang taon. Equivalent po iyan to more than one million a month (Almost 12.5 million claimants are being processed by them in a year. That is equivalent to more than one million a month),” he added.

Earlier, PhilHealth has introduced the application of a debit-credit payment method (DCPM) to conveniently settle accounts payable to health care facilities (HCFs) during the global pandemic.

According to Gierran, around 60 percent of claims were paid under DCPM, and more or less 40 percent of claims are still being meticulously validated to ensure that there are no funds that would go to waste.

Go also mentioned that PhilHealth is in coordination with the National Bureau of Investigation (NBI) to probe cases with false claims to further prevent corruption and delay of processes.

As the senator from Davao acknowledged the struggles of many hospitals to respond to the COVID-19 pandemic, Go also pleaded to hospitals to remain cooperative and honest with their claims, especially during these unprecedented times.

“Please validate your claims and make sure they are correct, accurate, and compliant with the law,” Go expressed.

Kaysa maubos ang ating oras sa pagba-validate ng claims at pagpa-file ng kaso sa mga nanloloko diyan, magtulungan tayo upang masigurong walang masasayang o mananakaw na pera, at mas mapapabilis ang tulong sa tao (Instead of consuming our time in validating and in filing cases against those who have fooled around, let us first help each other in ensuring that no money will go to the pockets of the crooks, and to further speed help the provision of help to the people) ,” he added.

Go further stressed the need for PhilHealth to settle unpaid reimbursements as he expressed his concern that it might affect the ability of health service providers to respond to the medical needs of Filipinos especially amid an ongoing pandemic.

In addition, Go mentioned that President Duterte assigned the Department of Information and Communications Technology (DITC) and other government agencies to help PhilHealth address backlogs and streamline their operations.

Nananawagan po akong muli sa pamunuan ng PhilHealth na bilisan pa ang kanilang processing ng mga lehitimong claims ng mga ospital para hindi maantala ang operasyon at hindi maapektuhan ang serbisyo ng mga health service providers sa mga tao (I am calling again on the leadership of PhilHealth to act fast on the processing of the legitimate claims of the hospitals to avoid delay in their operation and it will no longer affectthe service of the health service providers),” he said.

The senator also emphasized that PhilHealth must intensify its response to the pandemic and must fulfill its financial obligations promptly as this would greatly help the nation particularly in this time of crisis situation.