Philippine Health Insurance Corp. members who have paid for COVID-19 swab tests out of their own pocket are entitled to a refund, according to Deputy Majority Leader and Bagong Henerasyon Rep. Bernadette Herrera.
Herrera said PhilHealth members who are classified as eligible for testing based on the guidelines issued by the Department of Health could avail of the state health insurer’s COVID-19 testing benefit package worth up to P3,409.
“There is a PhilHealth circular that allows members who are eligible for testing to file reimbursement claims for COVID-19 polymerase chain reaction test, but unfortunately the public is not fully aware of this benefit,” Herrera said.
“I urge all qualified PhilHealth members, who have personally paid for their COVID-19 tests, to directly file their reimbursement claims with PhilHealth to prevent unscrupulous private hospitals and testing centers from pocketing these funds by claiming the benefit on behalf of PhilHealth members,” she added.
Herrera earlier bared a new anomaly in PhilHealth in connection with the reimbursement of PCR tests already paid for personally by members.
Herrera said she received complaints that some PhilHealth members were asked by hospitals and laboratories to give their identification numbers for reimbursement of COVID-19 tests that they paid out of their own pocket.
She said she is certain President Rodrigo Duterte will get mad if he finds out about the new PhilHealth reimbursement anomaly, as well as the low utilization of budget for free COVID-19 testing.
Herrera also expressed hope that new PhilHealth president and CEO Dante Gierran will look into the matter and consider instructing all DOH accredited testing centers to accommodate PhilHealth members.
She said the newly-discovered PhilHealth reimbursement anomaly is rooted in severe lack of public information that certain sectors are allowed to have COVID-19 tests for free.
Herrera said the DOH had issued guidelines identifying 10 subgroups of at-risk individuals who are given priority for free PCR testing, which include patients with severe symptoms and mild symptoms but with travel history or contact, health care workers, senior citizens and returning overseas Filipino workers.
Also identified to undergo regular free PCR test are workers in the tourist zones, local manufacturing companies, transport and logistics, food retail, education, financial services, non-food retail, services, public market, construction; water supply, sewerage, and waste management; public sector, and mass media.
Herrera said that under PhilHealth Circular 2020-0017, all at-risk individuals mentioned in the DOH guidelines are entitled to COVID-19 testing benefit package.
Under the circular, members may be reimbursed the amount not exceeding the corresponding benefit for COVID-19 test if such benefit was not availed of or was not deducted from the actual charges, provided the requirements are complied with.
Among the documents to be submitted are properly accomplished claims summary form, original copy of the official receipt, and a waiver issued by the PhilHealth accredited testing laboratory that the member paid the full amount for the test and no PhilHealth deduction was made.
PhilHealth has set the rate of its COVID-19 testing package at P3,409 if all services for testing will be procured and provided by the testing laboratory.
This can even go lower to P2,077 provided that the test kits that will be used are donated to the laboratory, and P901 if the test kits are donated and the PCR machine is in the budget of the testing facility.
Citing PhilHealth’s own records, Herrera said the state health insurer has a budget between P27.88 billion and P29.77 billion for 10.12 million COVID-19 tests.
However, the legislator lamented that only 2.39 percent of the total number of tests have been done and 9.6 percent has been spent by PhilHealth out of its total budget for test claims.
As of last August 17, a total of 105 testing centers are accredited under this system, with 42 in the National Capital Region alone. In its report dated September 4, PhilHealth said that only 11,416 claims were paid prior to June 25 and a dismal 1,152 claims were paid after that same date.