Billions of pesos in unpaid health claims by the state-owned Philippine Health Insurance Corp. (PhilHealth) could affect the ability of private hospitals to treat COVID-19 patients, an official said Monday.
Dr. Jose Rene De Grano, president of the Private Hospitals Association of the Philippines Inc. (PHAPi), said the delayed reimbursements would be used to pay for the salaries of healthcare workers, medical equipment, and supplies.
“These delays will have a huge impact because we rely only on our services and the admission of our patients,” De Grano said in Filipino.
“If there are no funds, this will affect the salary of our employees, our capacity to buy medical supplies and pay for oxygen,” he said.
The Philippine Hospital Association (PHA) had said that PhilHealth owed private and public medical facilities some P20 billion in COVID-19 claims.
De Grano said its members in the Visayas and Mindanao had yet to receive reimbursements from PhilHealth.
De Grano said private hospitals usually received moderate, severe, or critical COVID-19 cases and received about P143,000 for moderate cases.
“If you have 10 patients, in two weeks’ time that's P1.4 million or around P2.8 million in a month," De Grano said.
Health Secretary Francisco Duque III said while he wanted PhilHealth to reimburse hospitals as soon as possible, he called on the hospitals to wait to ensure the funds that would be disbursed would be "legally defensible."
"They continue to do reconciliation of their figures because there seems to be a difference between what the hospitals are submitting versus what PhilHealth has established as payables to the private hospitals," Duque said in an interview with ANC's Headstart.
"You see, PhilHealth is subject to COA auditing rules and regulations, and it just simply wants to ensure that any taxpayer or contributor’s money that is paid to the hospitals as its partners has legal basis," he said.
The PHA said Monday they will meet with PhilHealth on Tuesday to clarify "uncertainties" regarding the coverage for COVID-19 patients.
PHA president Dr. Jaime Almora, in an interview with GMA News, said they also want clarification on the role of smaller hospitals in the COVID-19 response.
Some memorandum circulars and orders from the state insurer cause “information disconnect” among regional offices and confusion among hospitals, he said.
He said that hospitals are engaging in a gamble when admitting COVID-19 patients because they are not sure if PhilHealth will accept them and cover their expenses.
Senators Juan Edgardo Angara and Grace Poe earlier urged PhilHealth to expedite the release of hospital claims amid the threat of the Delta coronavirus variant in the country.
Angara cited the report of PHA saying several of its members have been experiencing severe financial distress due to their unpaid claims from PhilHealth.
According to Almora, the claims of their members range from P50 million to P700 million, but one hospital's unpaid claims have already reached P1.2 billion.
Poe called on PhilHealth and the Department of Budget and Management to "work harder" to expedite the release of funds for health workers and hospitals.