Ako-Bicol Party-list Rep. Rep. Zaldy Co (Facebook)

House Committee on Appropriations Chairman Ako-Bicol Party-list Rep. Rep. Zaldy Co has asked the Philippine Health Insurance Corp. (PhilHealth) to reimburse government hospitals of their claims as soon as possible. 

During the briefing on the 2025 budget of the Department of Health (DOH) on Wednesday,  Sept. 4, it was learned that PhilHealth’s unpaid claims have reached P14.8 billion, of which P6.7 billion have been pending for over two years. 

“Ang hirap na dine-deny ang bayad sa mga services na na-perform na. Parang sinasabi na, huwag na tayong magpagamot. Dapat once na inaccept na ng government hospital yung mga pasyente, automatic na yun kasi binayaran na yung contribution ng tao, nabigay na ang subsidy,” said Co. 

(It is problematic to deny payment of services already performed. It’s as if we’re saying, don’t get treated. Once the government hospital accepts the patient, PhilHealth should automatically pay because the people’s contribution has already been paid, the subsidy has already been given.) 

In the same budget briefing, Co asked DOH Secretary Teodoro Herbosa about the inclusion of doctors’ professional fees under the Medical Assistance for Indigent and Financially Incapacitated Patients (MAIFIP) program. 

Herbosa, who had committed to resolve the issue in a meeting with Co and Speaker Martin Romualdez last week, said he has already released a department memorandum on the matter. 

“Sa mga doctors natin sa DOH, dapat i-approve automatic yan. Huwag nang i-deny ang mga professional fee kasi kawawa, mababa na nga ang sweldo. Dapat wala na silang alalahanin sa fee nila," the ranking congressman said. 

(Our DOH doctors’ professional fees should be automatically approved, not denied. Their salaries are already pitifully low. They should not have to worry about their fees.) 

Responding to Co's concerns, PhilHealth President Emmanuel Ledesma vowed to expedite the processing and payment of the claims that have either been returned to hospital (RTH) for fulfillment of unmet requirements or outrightly denied. 

Co said PhilHealth should help ensure that government hospitals, which cater to massive numbers of poor patients, deliver proper health services by paying their claims promptly. He said cash flow problems seriously impact the public health care system. 

“Kung ghost claims, idecline. Kung kulang na period o comma ang claims documents, huwag na pahirapan…Para sa taumbayan ito. Suportado ng Kongreso at ng budget, at may pera para ma-provide ang services,” he said. 

(Ghost claims must be denied. But if the claims documents are missing just a period or a comma, don’t make it difficult for the hospitals…This is for the people, and it’s supported by Congress and the budget, and there is money for the services.)