PhilHealth should tap independent body to review claims — Gordon

Published August 25, 2021, 10:19 AM

by Vanne Elaine Terrazola

The Philippine Health Insurance Corporation (PhilHealth) could use the help of an independent agency to review hospital claims if it cannot do the job, Senator Richard Gordon has proposed.

Senator Richard Gordon (MANILA BULLETIN File Photo)

Gordon floated the idea following statements from hospitals’ associations that they may be forced to disengage with the state health insurer due to the delay in their reimbursements, as a result of a recent circular suspending the payment of their claims.

“Siguro, it is about time that ‘yong pagrereview ng collection ibigay sa independent agency. Baka hindi niyo kaya (Maybe it is about time that the review of collections be given to an independent agency. Maybe you cannot do the job),” Gordon said of the PhilHealth during a online interview with reporters Tuesday, August 24.

“Baka ‘yong inyong computer programs ay baka hindi abot (Maybe your computer programs are not enough),” he noted.

Gordon said the PhilHealth must pay the reimbursements lest it subjects itself anew to investigations.

“Bakit ‘di niyo nababayaran? Saan niyo dinadala yong pera? Bakit tsina-tsani niyo (Why can’t you pay them? Where are you bringing the money? Why are you nitpicking)?” the chairman of the Senate Blue Ribbon Committee said.

“They are sticking their jaw out,” Gordon said.

The PhilHealth suspended its payouts for 120 days as it investigates claims of health care providers for “fraudulent acts, unethical acts and abuse of authority”.

The Private Hospitals Association of the Philippines warned that hospitals are now reconsidering their engagement with the PhilHealth. Should they disengage, patients of private hospitals may need to advance their payments and file their benefits directly to the PhilHealth, the group said.