PhilHealth takes blame over circular on Covid treatment benefit package


The House Committee on Health on Tuesday adopted a resolution directing the Philippine Health Insurance Corp. (PhilHealth) to review its issuances and immediately rectify its mistake after admitting that there was delay in the retroactivity of its circular on Covid-19 benefit package.

During a panel hearing, committee Chairman and Quezon Rep. Angelina “Helen” Tan said her House Resolution 1966 was filed to inquire into the apparent confusion brought about by the issuances of PhilHealth on the availment of Covid-19 related benefit packages.

According to Tan, PhilHealth made several amendments and supplemental issuances on the availment of the Covid-19 benefit packages as the pandemic situation continuously evolve over time eventually causing public confusion, especially on those who had been infected and interested to avail of the benefit packages.

“Millions of Covid-19 probable claims are in danger of being denied as a result of PhilHealth’s turnaround causing huge losses to health-care facilities, which clinically managed a probable Covid-19 case and eventually causing financial hardship to the Covid-19 patient whose claim will be denied due to fear of prosecution of signatories involved in the approval of the claims,” Tan said.

Tan raised the issue of PhilHealth’s retroactive application of PhilHealth Circular 2021-008, which was only “circularized” in June 2021, but was subsequently applied in November 2020 or seven months before the official issuance of the circular.

PhilHealth Circular 2021-008 provides that only claims for confirmed Covid-19 cases based on a positive Covid-19 swab test results or RT-PCR test shall be covered by the existing Inpatient Covid-19 Package.

“The retroactive application of the circular removes the probable cases from entitlement under PhilHealth Circular 2020-009, which provides for the same benefits as that of confirmed cases and downgrades the same to an intermediate package,” Tan said.

“This will cause huge losses to hospitals that have already rendered service and processed the claims as well as patients who were already entitled to such claim prior to the issuance of PhilHealth Circular 2021-008,” she added.

The lawmaker said the enactment of the landmark Republic Act 11223 or the Universal Health Care (UHC) Act, has bolstered PhilHealth’s function as the “national purchaser” of health goods and services—placing it to be in charge of paying health-care providers like hospitals and clinics for services given to Filipinos by pooling more funds so PhilHealth can cover all Filipinos and provide more services.

“House Resolution 1966 should not be construed as pointing a finger at PhilHealth but as a way by which to guide those Filipinos who, unfortunately, must avail of its Covid-19 benefit packages,” Tan said.

Tan also called on the PhilHealth Board and leadership to get their act together and to be more considerate, especially during this time of the pandemic in the midst of hospital closures and threats of mass walk out of health personnel.

For his part, PhilHealth President Atty. Dante Gierran clarified that various modifications made on the benefit packages are not only inevitable but also necessary, as the state social health insurer needs to continuously review the Covid-19 packages in the face of evolving protocols.

He and other officials, however, admitted PhilHealth’s lapses that resulted in the delay on the issuance of the circular and promised to resolve the infirmity in its policy.

Eli Dino Santos of PhilHealth said that it couldn’t be denied that there is delay in the issuance of the circular.

“There’s so many reasons and we will not provide excuses. It’s just that there were several circumstances that went beyond our control. It’s already late when the circular was published,” Santos said.

The PhilHealth, meanwhile, committed to bring the matter to the PhilHealth Board to immediately correct the oversight.

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