Major hospitals eye 'PhilHealth holiday' in protest of unpaid claims

Major hospitals in the country are gearing to observe a five-day “PhilHealth holiday” where deductions for health services will not be accepted, an official of the Private Hospitals Associations of the Philippines Inc. (PHAPI) announced Monday.

According to PHAPI President Dr. Jose Rene De Grano, the group is urging its members to refrain from accepting reimbursements involving the Philippine Health Insurance Corp. (PhilHealth) from January 1 to January 5, 2022.

“I-e-encourage namin ang aming miyembro na huwag munang tumanggap ng PhilHealth from January 1 to January 5, nang sa gano'n po ay gusto namin ipakita ang aming suporta sa mga kasamahan naming hospital,” he said in a radio interview.

“Hindi po kami tatanggap ng mga (PhilHealth na) pasyente, pero hindi muna po kami magde-deduct ng mga health benefits,” he added.

[We will encourage our members to temporarily stop accepting PhilHealth claims from January 1 to January 5 in support of other hospitals. We will not accept (PhilHealth) patients, but we will not deduct health benefits.]

This comes after seven private hospitals in Iloilo, along with the Far Eastern University-Dr. Nicanor Reyes Medical Foundation (FEU-NRMF) decided to cut ties with PhilHealth over the delayed payment of claims.

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.

PhilHealth last month said it is seeking to settle unpaid claims to private hospitals by December, as it blamed the lack of manpower amid the COVID-19 pandemic.

“Sana po ay maunawaan kami ng ating mga kababayan kung sakali mang matuloy itong aming binabalak na gagawin na ito,” said De Grano, claiming that the PhilHealth owes as much as P5 billion to hospitals in Metro Manila alone.

[We appeal for public understanding should we push through with the planned undertaking.]

Sought for comment, PhilHealth spokesperson Dr. Shirley Domingo appealed to De Grano and the PHAPI to reconsider their plan.

“We hope Dr. De Grano will rethink his call to his member hospitals to go on PhilHealth holiday. Eventually it will be the Filipino people who will suffer the consequences of such a call,” she said in a mobile message.

Domingo said PhilHealth has already expedited the P11.64-billion payment through the debit credit payment method (DCPM) to hospital partners as of December 24, 2021, with 182 hospitals submitting their letter of intent.

Under DCPM, only 60% would initially be paid to hospitals and the 40% would be paid upon completion of processing requirements.

“With the welfare of patients in mind, PhilHealth is constantly conducting reconciliation meetings on claims reimbursement issues with all its hospital partners nationwide to ensure continuing availment of members’ benefits,” she said.

Domingo earlier said PhilHealth is addressing the delayed payments using its DCPM, but De Grano called such a scheme “one-sided.”

“Puwede nilang i-suspend payment nitong DCPM for any reason deemed by PhilHealth… Hindi naman makatarungan,” he said in the same interview.

[They can suspend payments under the DCPM for any reason deemed by PhilHealth… That is not fair.] —KG, GMA News