The Philippine Health Insurance Corporation (PhilHealth) said on Tuesday, August 17, that it will reconsider its circular which removed the benefit package for probable COVID-19 cases.
During a hearing of the House of Representatives' Committee on Health, officials of the PhilHealth admitted their fault for the late issuance of the Circular (PC) No. 2021-08, which changed the benefit package for patients who have not been confirmed as infected by the novel coronavirus disease.
Quezon Representative Angelina "Helen" Tan, committee chairperson, said there was confusion among hospitals, and even PhilHealth regional offices, in the disposition of claims following the state insurer's recent circular.
Issued last June 17, PC 2021-08 amended the PC No. 2020-09 and effectively removed probable COVID-19 cases from its in-patient package.
The PhilHealth decided to apply a retroactive effect on the claims starting November 26, 2020, when members of its board actually approved the amendment.
Lawmakers raised concerns about the circular's impacts to hospitals, especially those that have already received reimbursements for probable COVID-19 cases. They also lamented that health care providers were not informed about the pending changes in PhilHealth's circular, with advisories issued only in May.
Tan said the burden should not be passed on to hospitals, especially they are already overwhelmed by the persisting pandemic.
"I admit...It cannot be denied that there is delay in this. There's so many reason and we will not provide excuses," PhilHealth acting executive vice president and chief operating officer Eli Dino conceded, taking responsibility for the delay.
"It's just that, Madam Chair, there were several circumstances that went beyond our control...And it's already late when the circular was published," he told the House panel.
PhilHealth senior vice president Jose Mari Tolentino said they aimed to protect the corporation's funds after learning of "serious cases" of upcasing and other fraudulent COVID-19 claims.
"When in truth and in fact, these cases shouldn't have been classified as COVID cases. This led to fraudulent claims before the PhilHealth that would ampunt to hundreds and thousands, or even millions of pesos," Tolentino explained.
PhilHealth president and chief executive officer Dante Gierran also spoke for his people, admitting that "there was some kind of delay" in the issuance of the circular.
Gierran said the matter has been discussed among PhiHealth officials, and that he will raise it to the PhilHealth Board for reconsideration.
"We will bring this matter back to the PhilHealth Board, because it is the board that approves policies," Santos assured.
After the four-hour hearing, the House health committee adopted the resolution seeking to urge the PhilHealth to "rectify the apparent mistake in the issued circulars regarding COVID-19 benefit package, review the soundness of the issuances to ensure just and fair policies to the Filipino people and expedite the action on the matter."
"Sana naman po hindi umabot uli ng seven months (I hope this does not take seven months again) dahil, even as we speak now, the lives of our kababayan are at stake. We already breached the 30,000 deaths. Thousands have been infected by this COVID-19, at kailangan mabilisan ang pagtugon sa mga pangyayaring ito (and we have to act fast on the situation)," Bayan Muna Rep. Carlos Zarate said.