PhilHealth president Dante Gierran vowed Thursday to pay 60 percent of the in-process claims of hospitals, which runs up to billions of pesos, by next week.
This developed as a Department of Health official called on the Philippine Health Insurance Corp. to prioritize the payment of “valid claims” of COVID-19 cases from private hospitals, which have threatened to disengage with the state insurer due to its unpaid debts.
“Because we know that PhilHealth is the lifeline of hospitals,” Health Undersecretary and treatment czar Leopoldo Vega told Teleradyo.
During the House committee on good government and public accountability hearing on the status of the state insurer’s unpaid claims to hospitals, it was disclosed that PhilHealth had P21.1 billion worth of unpaid claims.
PhilHealth has denied the claim, saying its unpaid claims only amounted to P12.9 billion.
“We will pay that next week, we know the hardships of hospitals. At present, we have the Debit-Credit Payment Method,” Gierran said.
The Palace and 20 major business groups on Wednesday also urged PhilHealth to pay private hospital claims as soon as possible and clean its ranks of erring personnel.
This came after private hospitals had threatened to cut ties with PhilHealth by next year due to the state-run corporation’s refusal to pay the claims of hospitals and healthcare institutions or providers that are subject to investigations.
In the same hearing, Gierran has lamented how the state-run agency was hurting from the recent controversies hounding it, including the unpaid hospital claims.
Gierran told the House Committee on Good Government and Public Accountability looking into PhilHealth’s unpaid claims to healthcare facilities: “I will tell you: We are hurt. I’m opening my heart, we are really hurting.”
Vega said the reimbursements would sustain the operations of private hospitals, which are suffering revenue losses due to lower patient footfall and lower non-COVID-19 admissions, he said.
Last week, the state insurer issued Circular 2021-0013, which suspends payment of claims “subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority” for a period of 120 days.
PhilHealth had said it was strengthening its measures to ensure the rational use of funds by detecting potential fraud or reimbursement abuse through dubious claims.
The Philippine Hospital Association disclosed that PhilHealth owed its members an average of P7 million each.
The state insurer owes hospitals some P13.6 billion in denied claims, with P13 billion to P16 billion in-process claims, and P46 billion Return to Hospital claims, said PHA president Dr. Jaime Almora.
The hospital group has some 1,100 members.
In related developments, Gierran said the head of the hospital association had admitted having “overreacted” to the agency’s temporary suspension of payments on claims under investigation.