Cagayan de Oro City 2nd district Rep. Rufus Rodriguez (PPAB)

Citing its harmful effects, Cagayan de Oro City 2nd district Rep. Rufus Rodriguez is urging the House of Representatives to look into the unpaid hospital reimbursement claims amounting to P59.6 billion from the Philippine Health Insurance Corporation (PhilHealth). 

“These non-payments of claims have resulted in the partial closure of some medical services of hospitals, and in some cases the full closure of hospitals,” Rodriguez said in House Resolution (HR) No.2173. 

He said workers had to be terminated due to the partial or full closure of hospitals, which was "likewise detrimental to Philhealth members who need medical care". 

“It is imperative that the House of Representatives investigate this non-payment of P59.6-billion worth of claims, and also look into ways to help hospitals comply with the law in order for them to be paid by PhilHealth,” he said. 

Rodriguez suggested that the Committee on Health conduct the proposed inquiry. He said the failure of state health insurer to reimburse hospitals for the past seven years was tackled in a recent hearing of the panel. 

The claims have been denied or returned to hospitals “for correction". 

PhilHealth Senior Vice President Renato Limsiaco has informed lawmakers that in 2024, there were 483,000 denied claims amounting to P4.7 billion; while from 2018 to 2023, around three million claims totaling P32.4 billion were rejected. 

The Department of Health (DOH) reported that most of the claims were denied because hospitals failed to file them within 60 days as required by law. 

Limsiaco also said PhilHealth had cash-on-hand amounting to P492 billion as of last Dec. 31. 

Rodriguez said that as per the Department of Budget and Management (DBM), PhilHealth “has the following funds which are available to them: P150 billion in surplus reserve funds, P203 billion in estimated premium collection for 2025, P80 billion in unfunded allotment of 2023 and 2024, (and) P21 billion in unreleased appropriations". 

“It was also mentioned that Philhealth has around P280 billion in reserves and P25 billion investment income in 2024. All this would total P759 billion, which could be accessed to pay for valid claims of hospitals,” he said. 

“In spite of the P759 billion in accessible funds, P59 billion is left unpaid to the detriment of the hospitals and Philhealth members served by said hospitals,” he stressed.