State-run Philippine Health Insurance Corporation (PhilHealth) clarified Friday it owed private hospitals around P16 billion—and not P20 billion as claimed by the Private Hospitals Association of the Philippines.
PhilHealth vice president for corporate affairs and spokesperson Shirley Domingo, in an interview on CNN Philippines, said majority of the claims pending with the state insurer are within the 60-day processing period—which means payment is not delayed.
Domingo said PhilHealth “receives around 39,000 claims a day and we also pay several millions of claims a day.”
“We actually pay P2.5 billion in benefit payments for a week,” she said.
“Right now, P16 billion is what is in our offices now and not all of that are delayed claims because there are some still within the 60 days and some outside of the 60 days [processing period],” she added.
The PhilHealth official said “maybe around less than 50 percent are still beyond the 60 days.”
On Thursday, PhilHealth corporate communications senior manager Rey Balena said the unpaid claims would be settled before December.
PhilHealth will be releasing the second wave of its DCMP scheme or Debit-Credit Payment Method to fast-track the processing of unpaid claims.
Under the DCPM, PhilHealth initially pays 60 percent of a hospital’s claim while the remaining 40 percent will be settled upon completion of pertinent requirements.
“Aside from the DCPM… we have instituted a lot of reforms in the way we process claims. One is, we are streamlining the number of steps in processing claims. Two, we have augmented our human resources in our claims processing unit. We have put in facilities in our IT system,” Domingo said.
The issue of unpaid claims came to light after several private hospitals have warned that they may not renew their accreditations with PhilHealth next year due to the late payment of claims.
“We understand them, we hope the situation will not reach that. We have some hospitals who have declared they’re not disengaging,” Domingo said.
“Our president, Atty. Dante Gierran, has been talking with the president of [the] Private Hospitals Association [of the Philippines] Dr. [Jose] De Grano to iron out issues to make sure that the situation will not push through because in the end it will be our fellow Filipinos who will not benefit from that kind of arrangement,” she added.
She said Philhealth has already released P158 billion in claims since January 2020.
“There’s no problem with funds to pay the claims,” Domingo said.
PhilHealth, under its charter, is tasked to administer the National Health Insurance Program, which aims to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines.
The Private Hospitals Association of the Philippines Inc (PHAPI) last week said some of its members might not renew their accreditation with PhilHealth because most claims for the treatment of COVID-19 patients last year remained unpaid.
The payment of some claims is delayed due to a shortage in PhilHealth's manpower, and errors and inconsistencies in hospitals' documents, Balena said.
