7-mo. delay in PhilHealth memo led to billions of unpaid claims

A seven-month delay in the routing of a Philippine Health Insurance Corporation (PhilHealth) circular on COVID-19 claims has resulted in billions of pesos that the agency owes hospitals, lawmakers learned Tuesday.

PhilHealth officials admitted during a congressional hearing the reported delay in the retroactivity of its circular on COVID-19 benefit packages.

“It is not acceptable that it took PhilHealth seven months to route the circular even though it was already approved by its board,” said House Committee on Health chairperson Quezon Rep. Angelina Tan.

“The circular is effective retroactively to November 26, 2020 and yet you issued that circular only on June 17, 2021,” Tan said as she scolded PhilHealth officials. “For me your answer that it took time to route that circular, although already approved by the board already, is not acceptable.”

Tan was referring to PhilHealth Circular 2021-0008, issued on June 17, 2021, which declared that “only confirmed cases shall be covered by the benefit package which shall be applied to cases starting November 26, 2020 and providing for an intermediate package which shall cover those cases which have been managed as COVID-19 cases.” 

Lawyer Eli Dino Santos of PhilHealth admitted the state agency was at fault over the delay.

“I admit. It cannot be denied that there was delay in this. There are so many reasons but 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.

PhilHealth president Dante Gierran assured lawmakers the issue is already being addressed.

“There was admission by my assistant, there was some kind of delay that was made by the Corporation and actually this was already discussed,” Gierran said.

Gierran said he would recommend to the PhilHealth board to “reconsider” the retroactive circular.