Hospitals claim Philhealth owes them P700-M; state insurer denies charge

At least 30 hospitals have asked the Philippine Health Insurance Corporation (PhilHealth) to settle millions worth of unpaid benefits they have allegedly been shouldering for several years.

In a report on 24 Oras by Cedric Castillo on Friday, Private Hospital Association of the Philippines Incorporated (PHAPI) president Dr. Rustico Jimenez said the insurance agency owes the claimants an amount that has ballooned to a total of P700 million.

"Hindi naman magsu-survive 'yung ospital kung walang pambayad sa nurses, pang-sweldo, security, pambayad sa gamot," he said.

Documents presented by PHAPI say PhilHealth owes the Manila East Medical Center in Taytay, Rizal around P41 million in unpaid claims that allegedly piled up over the last five years.

"Ang nangyari ngayon, the hospital is subsidizing the expenses of these patients... Wala silang specific date na sinabi na they can settle this problem," Manila East Medical Center president Dr. Juan Lagunzad said.

The Pacific Global Medical Center in Quezon City and Commonwealth Hospital and Medical Center in Novaliches said PhilHealth also owes them claims amounting to approximately P29.8 million and P48 million, respectively.

After receiving the list of hospitals demanding payment, PhilHealth denied it had P700 million in pending claims.

Philhealth said it only owes P5.5 million to the hospital and medical center that was asking for P29.8 million after making payments amounting to P483 million from 2014 to 2018.

PhilHealth also said it only owed P785,000 worth of payables to Pacific Global Medical Center that was asking for P48 million, saying it settled payments of P263 million in the last four years.

As the insurance agency has yet to release a detailed report, PhilHealth spokesperson Dr. Israel Pargas said: "At ang isang claim, maaaring una, mababayaran because it is a good claim. Pwede siyang ma-deny, or pwede ibabalik sa ospital because may mga pagkukulang.

"Kailangan din nating ma-reconcile kung 'yung mga hiniahap nilang claims, baka mamaya naman ay bayad na," he added.

PhilHealth also denied the payments were delayed, noting an improvement in the payment system he attributed to the E-Claims Submission System.

"Our data now would show we have improved tp a little less than 38 days processing already," he said.

Sought for comment Pacific Global said it has records to back their claims.

"Bigyan na natin ng palugit na 8 million so meron pa ring P40 million. Pero don't believe na aabot ng ganu'n kasi itong mga cases na ito, maliit na dito ang mga P2 million," Lagunzad said.

According to the implementing rules of the National Health Insurance Act, the insurance agency has 60 days to process the claims.

PHAPI had previously flagged PhilHealth in May 2016 over P600 million in delayed payments, which the insurance company said were due to the new system.  —Margaret Claire Layug/JST, GMA News