Philippine Health Insurance Corporation (PhilHealth) President and Chief Executive Officer Dante Gierran said the state health insurer has no “mistrust” towards its partner hospitals after being questioned by the Lower House on Thursday (Aug. 26) on its slow processing of claims.
During the House Committee on Good Governance and Public Accountability hearing, Batangas Fifth District Rep. Mario Vittorio "Marvey" Mariño, said some of the hospitals in his province had claims that were not processed for the first time but were processed the second time they submmitted, which caused confusion.
The solon added that some of the hospitals feel that they are being accused right away of “upscaling” because of the delay in the processing of their claims.
“Baka sa way of communication natin sa kanila, ay mali po yung dating sa kanila (Maybe your way of communicaiton with them, comes off different), that’s why they are up in arms. Nag iisip sila ng pararan kung paano at nag re-reklamo po sila (They are thinking of ways and they’re complaining),” Mariño said.
Gierran, for his part, said that some claims are returned to the hospitals, or denied because of documentary requirements.
Philhealth added that while it is true that there have been cases of "upscaling," it has never been a ground for the agency to misttruy their partner hsopitals.
Early this week, PhilHealth issued Circular No. 2021-0013, ordering the temporary suspension of payment claims of healthcare facilities that are “subject of investigation based on credible and verifiable report” by the state health insurer or "other duly authorized government agencies.”
Mariño meanwhile suggested that PhilHealth just focus on checking if the diagnosis in the claims are correct and pay hospitals right away, adding that the problem on document requirements can be resolved after.