Hospitals in the National Capital Region, Quezon province, northern Luzon, and General Santos City are following the lead of seven hospitals in Iloilo and are also planning to cut ties with state health insurer PhilHealth over unpaid claims.
Dr. Jose Rene de Grano, Private Hospital Association of the Philippines Inc. (PHAPI) national president, said this Monday in a Teleradyo interview even as the Philippine Health Insurance Corp. was celebrating a three-day PhilHealth Summit broadcast on its Facebook Live page.
Although he did not identify the other hospitals planning to leave, De Grano stressed that private hospitals that cut ties with PhilHealth would still serve the firm’s members — but the patients or their families would be the ones who would directly transact with the state insurer.
“Our private hospitals will still give them the same service,” the PHAPI president said. “But they will have to pay, and we will give them a statement of account, which they will refund directly to PhilHealth for their benefits.”
Last month, PhilHealth Spokesperson Shirley Domingo appealed to hospitals to rethink their plans of disengaging with the firm as it was working to settle the unpaid claims.
But with the non-renewal of the contracts, patients will have to process their claims and will have to pay in advance before they are reimbursed by PhilHealth.
This developed as the president of a private hospital in Iloilo City said Monday PhilHealth still owed it some P93 million, which is part of the P545 million in unpaid hospital claims that has prompted seven hospitals in Iloilo province to cut ties with the government health insurer.
“We still have a balance of about P93 million… this is a cumulative amount which started since 2018,” said Metro Iloilo Hospital and Medical Center President and CEO Danilo Encarnacion.
According to “24 Oras Weekend” report, the hospitals that will not renew their contracts with PhilHealth in January 2022 are St. Paul’s Hospital, Iloilo Doctors Hospital, Iloilo Mission Hospital, The Medical City – Iloilo, Medicus Medical Center, Qualimed Hospital Iloilo, and Metro Iloilo Hospital and Medical Center Inc.
Elmer Pedragosa, president of the PHAPI Western Visayas Chapter, said hospitals have been waiting for the payments to be made, but have yet to receive the full amount.
“We waited for October 31 for payment. We were expecting like 70 percent to 80 percent to be paid by Philhealth, but we only got an average of 15 percent to 20 percent payment,” said Pedragosa.
In 2018, PhilHealth owed the hospitals some P136 million but the insurer was able to gradually pay, Encarnacion said, during an interview with ABS-CBN’s Teleradyo.
“But the balance that remains is still big because not all claims are being honored,” he said.
PhilHealth returns many claims to their hospital, often with unclear reasons, Encarnacion said.
“PhilHealth’s evaluation, explanation is unclear. Most of the time, we don’t know why they are returning the claims because we don’t have much communication because we can’t directly contact them. What they want is to correspond through email… which is very difficult,” he said.
Under its mandate, PhilHealth 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.
Spokesperson Domingo said among the unpaid claims are those involving COVID-19 cases, which takes time to validate.
“It’s the COVID claims that are delayed and we are already addressing the issue through our DCPM — debit credit payment [method]. Previously, we were giving 60 percent of the amount of claims, good claims that are with us already, and we reconcile and then we give the remaining 40 percent if ever,” she said in the same report.
PhilHealth last month said it was seeking to settle unpaid claims to private hospitals by December, as it blamed the lack of manpower amid the COVID-19 pandemic.