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Manila Bulletin devider Philippines devider National devider Rodriguez bill compels PhilHealth to pay late hospital claims

Rodriguez bill compels PhilHealth to pay late hospital claims

Published Feb 4, 2025 06:32 am

At A Glance

  • A measure that will compel the Philippine Health Insurance Corporation (PhilHealth) to pay billions worth of reimbursement claims from hospitals and other health facilities has been filed in the House of Representatives just as the state health insurer was given a new leader.

A measure that will compel the Philippine Health Insurance Corporation (PhilHealth) to pay billions worth of reimbursement claims from hospitals and other health facilities has been filed in the House of Representatives just as the state health insurer was given a new leader.

Cagayan de Oro 2nd district Rep. Rufus Rodriguez on Monday, Feb. 3, filed House Bill (HB) No.11398, which ordered PhilHealth to implement a total amnesty and pay all claims that were filed late, "whether the claims are at the level of refiling, administrative protest, appeal, or denied with finality".

A day after, on Tuesday, Feb 4, Malacañang announced the appointment of orthopedic surgeon Dr. Edwin Mercado as PhilHealth's new president and chief executive officer (CEO).

Explaining his measure, Rodriguez cited the provision of the Constitution that directs the state to “adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost".

Under PhilHealth rules, accredited hospitals and other health facilities extend health services to Philhealth members.

Its rules also enforce a 60-day claims filing deadline. While it aims to streamline claims processing, it has also inadvertently resulted to the denial of P20 billion worth of claims from 2018-2024 due to late submissions, according to Rodriguez.

It also led to financial strain on health facilities, particularly those in underserved areas, and increased administrative burden due to returned claims and appeals, he added.

In fact, there is a recent Supreme Court (SC) ruling between PhilHealth and Chinese General Hospital and Medical Center that "highlighted the necessity of adopting a more flexible approach to claims processing".

"It also emphasized that strict procedural rules should not undermine the core objective of the national health insurance program, which is to ensure financial access to essential health services for all Filipinos,” he said.

He added that the SC upheld the decision of the Court of Appeals (CA) and ordered PhilHealth to pay the belatedly filed claims of Chinese General Hospital and Medical Center.

Rodriguez says his bill "seeks to address the countless Philhealth claims of health facilities which were denied due to late filing, giving significance to the principle of equitable payment of services that were already rendered."

"This bill also aims to support the role of health facilities in the realization of universal health in the country," he said.

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