Amid prospect of yet another Senate inquiry PhilHealth reports P166-billion payout to hospitals


The Philippine Health Insurance Corporation (PhilHealth) on Thursday said it has already paid a total of P166 billion for the claims it received from accredited government and private hospitals from last year until June 30 this year.

The state health insurer’s statement as Sen. Juan Edgardo Angara filed Senate Resolution 774 to verify reports and find out what is causing extended delays in PhilHealth reimbursements and fix the problem in case it requires remedial legislation.

The Resolution noted complaints recently conveyed by the Philippine Hospital Association, comprising 2,000 private and government hospitals, over unpaid PhilHealth reimbursement claims.

PhilHealth said the amount already covers 13.6 million claims or 76.4 percent of the almost 18 million claims it received during the period.

The remaining percentage of the claims were comprised of those returned to hospitals for compliance with identified deficiencies  (8 percent) and those that were denied due to non-compliance and various violations of existing rules and regulations.

“The Corporation is working double time to process the remaining 12 percent amounting to P25.6 billion, which are in varying levels of processing in its offices,” PhilHealth said in a news statement issued on Thursday.

Of the total claims received during the period, PhilHealth said almost 10 million claims were from accredited private hospitals, of which 8.2 million claims amounting to almost P96 billion has been paid, while the rest of the claims amounting to P14.4 billion is still under process.

In the same statement, PhilHealth also clarified that the P6.3 billion it paid to 206 hospitals as claimed by Private Hospitals Association of the Philippines Inc. (PHAPi) refers to the partial payments made by the state health insurer under the Debit-Credit Payment Method (DCPM) to hospitals with Covid-19 cases within the identified critical areas.

The state health insurer also attributed the discrepancy in the figures between PhilHealth and the hospitals mainly to the “differences in accounting treatments.”

“During the claims data reconciliation meetings with a number of hospitals, it was noted that hospitals have been including denied and returned-to-hospital claims in their accounts receivables while PhilHealth recognizes only good claims as its payables pursuant to prevailing government accounting rules and regulations. This accounting practice was earlier validated during the House Committee on North Luzon Growth Quadrangle hearing with hospitals and PhilHealth in June of this year,” it said.

On Monday, Senator Angara said the P6.3 billion in hospital claims released by PhilHealth to health-care facilities is a “measly amount” compared to the P28 billion in unpaid claims as stated by PHAPi.

The BusinessMirror sought PhilHealth to clarify how much remains to be paid under the DCPM scheme but it has yet to give a response on the matter as of press time.

In terms of Covid-19 related benefit claims, PhilHealth said it paid almost P12 billion, equivalent to 56 percent of the total received Covid-19 related claims from affected areas.

These claims consist of testing packages (inclusive of tests conducted by the Philippine Red Cross), community isolation benefit package and hospitalization cases.

At a recent Senate hearing, Dr. Jaime Almora, PHAPi president, told senators that the unpaid claims by member-hospitals now range from P50 million to P700 million.

Almora added that some hospitals had to resort to borrowing and used up savings just to maintain hospital operations.

This as Angara, sitting chairman of the Senate Committee on Finance, shared senators concerns over the possibility of growing number of patients likely to be afflicted with Covid-19  Delta variant.

He reminded that it is the government’s responsibility to ensure that there is enough capacity in private and public hospitals.

The senator stressed that piecemeal payments by PhilHealth will not do, as this will only lead hospitals to cut back on services and bed capacity and the operating hours of hospital personnel.

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